Organization
INTERMED OF BOCA RATON, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTAL BRAY (CEO)
(954) 254-7968
Entity
Organization
Contact information
Practice address
950 GLADES RD STE 4D, BOCA RATON, FL 33431-6401
(561) 391-8086
(954) 354-8151
Mailing address
4855 W HILLSBORO BLVD, SUITE B2, COCONUT CREEK, FL 33073-4356
(954) 418-1683
(954) 354-8151
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
74563
MEDICARE
FL
Enumeration date
01/07/2016
Last updated
07/12/2021
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