# LIFE MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245607589
- **Authorized official:** MARK L VOLLARO (PRESIDENT)
- **Authorized official phone:** (866) 954-8281

## Contact information

- **Practice address:** 1901 S CONGRESS AVE, SUITE 150, BOYNTON BEACH, FL 33426-6556
- **Practice address phone:** (866) 954-8281
- **Mailing address:** 12718 OAK RUN CT, BOYNTON BEACH, FL 33436-6134
- **Mailing address phone:** (866) 954-8281

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/21/2015
- **Last updated:** 08/21/2015