Organization
BOCACARE 9TH AVENUE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY J FEDELE (CEO)
(561) 392-6666
Entity
Organization
Contact information
Practice address
1599 NW 9TH AVE, SUITE 203, BOCA RATON, FL 33486-1310
(561) 392-6666
(561) 392-1583
Mailing address
1599 NW 9TH AVE, SUITE 203, BOCA RATON, FL 33486-1310
(561) 392-6666
(561) 392-1583
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME42340
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
73258
BCBS
FL
Enumeration date
08/18/2009
Last updated
08/18/2009
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