MEDICARE: MR. EUGENE LEON WAY II CRT

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	2278C0205X	Critical Care Certified Respiratory Therapist
2	2278C0205X	Critical Care Certified Respiratory Therapist	TT7754	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922690486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EUGENE LEON WAY II CRT

Provider Business Mailing Address
First Line	:	747 KINGSTON CT
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-2428
Country	:	US
Telephone Number	:	813-787-8267
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 CAMINO GARDENS BLVD STE 104
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33432-5823
Country	:	US
Telephone Number	:	561-494-4499
Fax Number	:

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

Provider Enumeration Date	:	02/06/2021
Last Update Date	:	02/06/2021

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