Basic Information
| Provider Information | |||||||||
| NPI: | 1528368263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERFAILLIE | ||||||||
| FirstName: | ERIC | ||||||||
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| Credential: | PA-C, MMS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5325 GREENWOOD AVE | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334072452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618446363 | ||||||||
| FaxNumber: | 5618448354 | ||||||||
| Practice Location | |||||||||
| Address1: | 5325 GREENWOOD AVE | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334072452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618446363 | ||||||||
| FaxNumber: | 5618448354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2010 | ||||||||
| LastUpdateDate: | 10/28/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9105726 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.