Provider Demographics
NPI:1326056789
Name:BOCA RATON PEDIATRIC ASSOCIATES PA
Entity Type:Organization
Organization Name:BOCA RATON PEDIATRIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WEXLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-392-7266
Mailing Address - Street 1:951 NW 13TH ST
Mailing Address - Street 2:SUITE 5D
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2359
Mailing Address - Country:US
Mailing Address - Phone:561-392-7266
Mailing Address - Fax:
Practice Address - Street 1:951 NW 13TH ST
Practice Address - Street 2:SUITE 5D
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2359
Practice Address - Country:US
Practice Address - Phone:561-392-7266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24757Medicare ID - Type Unspecified