Organization
ID OF PLYMOUTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER T HALEY MD (AUTHORIZED GROUP OFFICIAL)
(561) 314-2000
Entity
Organization
Contact information
Practice address
110 LONG POND RD STE 202, PLYMOUTH, MA 02360-2642
(508) 747-4424
Mailing address
4700 EXCHANGE CT STE 110, BOCA RATON, FL 33431-4450
(561) 314-2000
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
08/25/2021
Last updated
08/25/2021
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