Basic Information
| Provider Information | |||||||||
| NPI: | 1922237932 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROYAL PALM BEACH MEDICAL, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 PONCE DE LEON ST | ||||||||
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| City: | ROYAL PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334111213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617919090 | ||||||||
| FaxNumber: | 5617919071 | ||||||||
| Practice Location | |||||||||
| Address1: | 10151 ENTERPRISE CENTER BLVD | ||||||||
| Address2: | STE 205 | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334373759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545338400 | ||||||||
| FaxNumber: | 9545338500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2009 | ||||||||
| LastUpdateDate: | 07/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | PAPA | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5617919090 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.