1750403036 NPI number — SHAWNNA M HAMPTON DO PLLC

Table of content: DR. BRUCE HILARY PURMELL D.D.S (NPI 1154547644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750403036 NPI number — SHAWNNA M HAMPTON DO PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAWNNA M HAMPTON DO PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750403036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 970154
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33497-0154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-289-9467
Provider Business Mailing Address Fax Number:
561-826-8971

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 N MILITARY TRL
Provider Second Line Business Practice Location Address:
#205
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33431-6365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-289-9467
Provider Business Practice Location Address Fax Number:
561-826-8971
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAMPTON
Authorized Official First Name:
SHAWNNA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-289-9467

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  OS9304 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 276068100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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