Provider Demographics
NPI:1205163250
Name:ROYAL PALM BEACH MEDICAL GROUP INC.
Entity type:Organization
Organization Name:ROYAL PALM BEACH MEDICAL GROUP INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRIMARY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEMIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORCIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-793-1475
Mailing Address - Street 1:11903 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-7644
Mailing Address - Country:US
Mailing Address - Phone:561-793-1475
Mailing Address - Fax:561-793-1478
Practice Address - Street 1:11903 SOUTHERN BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-7644
Practice Address - Country:US
Practice Address - Phone:561-793-1475
Practice Address - Fax:561-793-1478
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROYAL PALM BEACH MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-12
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014607400Medicaid
FL101524700Medicaid