Provider Demographics
NPI:1144979949
Name:MD HEALTHCARE BOCA RATON LLC
Entity type:Organization
Organization Name:MD HEALTHCARE BOCA RATON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENATO
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-301-4164
Mailing Address - Street 1:304 INDIAN TRACE
Mailing Address - Street 2:SUITE 636
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326
Mailing Address - Country:US
Mailing Address - Phone:786-553-9745
Mailing Address - Fax:
Practice Address - Street 1:7050 W. PALMETTO PARK ROAD
Practice Address - Street 2:SUITE 30
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:954-425-9154
Practice Address - Fax:866-981-1882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024422400Medicaid