Provider Demographics
NPI:1003007014
Name:DELRAY FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:DELRAY FAMILY PRACTICE INC
Other - Org Name:THE FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAZZOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-987-2900
Mailing Address - Street 1:3816 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6750
Mailing Address - Country:US
Mailing Address - Phone:954-987-2900
Mailing Address - Fax:954-987-2986
Practice Address - Street 1:3816 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6750
Practice Address - Country:US
Practice Address - Phone:954-987-2900
Practice Address - Fax:954-987-2986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6603208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI637Medicare PIN