Provider Demographics
NPI:1093915316
Name:NEIGHBORHOOD FAMILY DOCTOR
Entity Type:Organization
Organization Name:NEIGHBORHOOD FAMILY DOCTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMININSTRATIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:ITA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-969-1777
Mailing Address - Street 1:4949 S CONGRESS AVE
Mailing Address - Street 2:STE B
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4731
Mailing Address - Country:US
Mailing Address - Phone:561-969-1777
Mailing Address - Fax:
Practice Address - Street 1:4949 S CONGRESS AVE
Practice Address - Street 2:STE B
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4731
Practice Address - Country:US
Practice Address - Phone:561-969-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18697AMedicare PIN