Basic Information
| Provider Information | |||||||||
| NPI: | 1255613881 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IBIS MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 740177 | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334740177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617402900 | ||||||||
| FaxNumber: | 5617402901 | ||||||||
| Practice Location | |||||||||
| Address1: | 10151 ENTERPRISE CTR | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334373759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617370211 | ||||||||
| FaxNumber: | 5617377433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2011 | ||||||||
| LastUpdateDate: | 09/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | TOWBIN | ||||||||
| AuthorizedOfficialFirstName: | BRADLEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5617370211 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME65968 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.