Provider Demographics
NPI:1285670141
Name:PRIMARY CARE PRACTITIONERS OF WEST PALM BEACH
Entity Type:Organization
Organization Name:PRIMARY CARE PRACTITIONERS OF WEST PALM BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:METZLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-832-2100
Mailing Address - Street 1:200 S ROSEMARY AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5746
Mailing Address - Country:US
Mailing Address - Phone:561-832-2100
Mailing Address - Fax:561-832-2030
Practice Address - Street 1:200 S ROSEMARY AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5746
Practice Address - Country:US
Practice Address - Phone:561-832-2100
Practice Address - Fax:561-832-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94723OtherBC/BS
FL94723OtherBC/BS
FL=========OtherTAX ID