Organization
PENINSULA DIAGNOSTICS PA
Active
Organization
PENINSULA DIAGNOSTICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL PACKARD MD (OWNER)
(888) 395-4007
Entity
Organization
Contact information
Practice address
1355 W PALMETTO PARK RD, #282, BOCA RATON, FL 33486-3330
(888) 395-4007
(888) 395-3941
Mailing address
1355 W PALMETTO PARK RD, #282, BOCA RATON, FL 33486-3330
(888) 395-4007
(888) 395-3941
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
ME30779
FL
Other
Enumeration date
01/14/2010
Last updated
01/14/2010
Update your record
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