MEDICARE: MEDPLUS MEDICAL CENTER, INC

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	207Q00000X	Family Medicine Physician		FL

General Provider Information

NPI Number	:	1932533353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDPLUS MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	2887 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4127
Country	:	US
Telephone Number	:	305-748-9310
Fax Number	:

Provider Business Practice Location Address
First Line	:	2887 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4127
Country	:	US
Telephone Number	:	305-748-9310
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	DONNA MEDOR
Credential	:
Telephone Number	:	305-748-9310

Provider Enumeration Date	:	08/22/2013
Last Update Date	:	08/22/2013

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