Basic Information
| Provider Information | |||||||||
| NPI: | 1023050416 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST BOCA VASCULAR SURGERY P A | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 970818 | ||||||||
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| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334970818 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3467 W HILLSBORO BLVD | ||||||||
| Address2: | |||||||||
| City: | DEERFIELD BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334429421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614833989 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 10/27/2010 | ||||||||
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| AuthorizedOfficialLastName: | ABDALLAH | ||||||||
| AuthorizedOfficialFirstName: | MOHAMMED | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5614833989 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | OS8138 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.