Provider Demographics
NPI:1093742124
Name:ROYAL PALM INTERNIST, P.A.
Entity Type:Organization
Organization Name:ROYAL PALM INTERNIST, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-703-2047
Mailing Address - Street 1:15340 JOG RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2170
Mailing Address - Country:US
Mailing Address - Phone:561-730-2047
Mailing Address - Fax:561-734-5490
Practice Address - Street 1:15340 JOG RD
Practice Address - Street 2:SUITE 202
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2170
Practice Address - Country:US
Practice Address - Phone:561-730-2047
Practice Address - Fax:561-734-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty