Individual
MU SU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
800 MEADOWS RD, BOCA RATON, FL 33486-2304
(561) 955-4730
(561) 955-2127
Mailing address
PO BOX 198227, ATLANTA, GA 30384-8227
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
ME 109094
FL
207ZH0000X
Hematology (Pathology) Physician
ME 109094
FL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME 109094
FL
Other
Enumeration date
06/11/2007
Last updated
05/12/2026
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