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Organization
PURE AGE MANAGEMENT LLC
Active
Organization
PURE AGE MANAGEMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KARL E VAETH (OWNER/MANAGING PARTNER)
(561) 225-9922
Entity
Organization
Contact information
Practice address
1054 GATEWAY BLVD, SUITE 103, BOYNTON BEACH, FL 33426-8301
(561) 847-4654
(561) 847-4956
Mailing address
1054 GATEWAY BLVD, SUITE 103, BOYNTON BEACH, FL 33426-8301
(561) 847-4654
(561) 847-4956
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME83769
FL
207RI0001X
Clinical & Laboratory Immunology (Internal Medicine) Physician
ME83769
FL
2083B0002X
Obesity Medicine (Preventive Medicine) Physician
ME83769
FL
2083T0002X
Medical Toxicology (Preventive Medicine) Physician
ME83769
FL
291U00000X
Clinical Medical Laboratory
10D2100646
FL
363AM0700X
Medical Physician Assistant
PA9106969
FL
Other
Enumeration date
02/24/2016
Last updated
02/24/2016
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