Provider Demographics
NPI:1881910073
Name:JAG MEDICAL OF PALM BEACH PA
Entity type:Organization
Organization Name:JAG MEDICAL OF PALM BEACH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-432-5101
Mailing Address - Street 1:6169 S JOG RD
Mailing Address - Street 2:STE 4B
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-6514
Mailing Address - Country:US
Mailing Address - Phone:561-432-5101
Mailing Address - Fax:561-432-1914
Practice Address - Street 1:6169 S JOG RD
Practice Address - Street 2:STE 4B
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-6514
Practice Address - Country:US
Practice Address - Phone:561-432-5101
Practice Address - Fax:561-432-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80421Medicare PIN