MEDICARE: MRS. LORI BETH OSWALD PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	5601002121	MI
2	363AS0400X	Surgical Physician Assistant	PA9105268	FL

General Provider Information

NPI Number	:	1922051770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI BETH OSWALD PA-C

Provider Business Mailing Address
First Line	:	11020 RCA CENTER DR STE 2010
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4277
Country	:	US
Telephone Number	:	561-881-8800
Fax Number	:	561-848-5878

Provider Business Practice Location Address
First Line	:	11020 RCA CENTER DR STE 2010
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4277
Country	:	US
Telephone Number	:	561-881-8800
Fax Number	:	561-848-5878

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	12/16/2014

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