Provider Demographics
NPI:1639365182
Name:PALM BEACH PHYSICIANS, PA
Entity type:Organization
Organization Name:PALM BEACH PHYSICIANS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENEDICTO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANPEDRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-967-1221
Mailing Address - Street 1:3731 LAKE WORTH ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461
Mailing Address - Country:US
Mailing Address - Phone:561-967-0234
Mailing Address - Fax:561-439-4833
Practice Address - Street 1:3731 LAKE WORTH ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461
Practice Address - Country:US
Practice Address - Phone:561-967-0234
Practice Address - Fax:561-439-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
FLARNP733712207Q00000X
FLME29312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058858000Medicaid
FLD86318Medicare UPIN
FL058858000Medicaid