Provider Demographics
NPI:1942823711
Name:HOPE MEDICAL PA
Entity Type:Organization
Organization Name:HOPE MEDICAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-843-8460
Mailing Address - Street 1:11419 W PALMETTO PARK RD UNIT 97081
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33497-2501
Mailing Address - Country:US
Mailing Address - Phone:561-843-8460
Mailing Address - Fax:561-922-3211
Practice Address - Street 1:11419 W PALMETTO PARK RD
Practice Address - Street 2:UNIT 97081
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33497-2501
Practice Address - Country:US
Practice Address - Phone:561-843-8460
Practice Address - Fax:561-922-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS10255OtherMEDICAL LICENSE