Provider Demographics
NPI:1225448921
Name:THE PALM BEACH CENTER FOR FACIAL PLASTIC & LASER SURGERY, P.A.
Entity Type:Organization
Organization Name:THE PALM BEACH CENTER FOR FACIAL PLASTIC & LASER SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:AZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-429-5403
Mailing Address - Street 1:4495 MILITARY TRL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4839
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4495 MILITARY TRL STE 202
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-429-5403
Practice Address - Fax:561-626-6277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117560207YS0123X
FLME134770207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty