Organization
BLUE WATER DOCTORS OF LAKE WORTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH J DICAPUA (MGMR)
(561) 843-7720
Entity
Organization
Contact information
Practice address
4801 S CONGRESS AVE, SUITE 304, LAKE WORTH, FL 33461-4746
(954) 586-8058
Mailing address
5215 COCONUT CREEK PKWY, MARGATE, FL 33063-3916
(954) 586-8058
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/26/2012
Last updated
09/26/2012
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