Etelmed MD Network

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

ETELMED MD NETWORK

Practice address

5489 Wiles Rd
Suite 302
Coconut Creek, FL 33073-4220

Phone

(954) 917-7144

NPI assigned

Jan 5, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lancelot James

Title

Ceo

Phone

(954) 917-7144

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1420416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420416000000",
    "number": "1841688462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5489 WILES RD",
            "address_2": "SUITE 302",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330734220",
            "telephone_number": "954-917-7144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5489 WILES RD",
            "address_2": "SUITE 302",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330734220",
            "telephone_number": "954-917-7144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETELMED MD NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-05",
        "last_updated": "2015-01-05",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "LANCELOT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "954-917-7144"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.