Provider Demographics
NPI:1881217081
Name:DR B MEDICAL PLLC
Entity Type:Organization
Organization Name:DR B MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:BAGENHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-757-5530
Mailing Address - Street 1:1905 CLINT MOORE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2660
Mailing Address - Country:US
Mailing Address - Phone:561-757-5530
Mailing Address - Fax:561-430-3590
Practice Address - Street 1:1905 CLINT MOORE RD STE 202
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2660
Practice Address - Country:US
Practice Address - Phone:561-757-5530
Practice Address - Fax:561-430-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty