Provider Demographics
NPI:1588787337
Name:JUPITER ORTHOPAEDIC PARTNERS LLC
Entity type:Organization
Organization Name:JUPITER ORTHOPAEDIC PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:RONDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-694-8945
Mailing Address - Street 1:601 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458
Mailing Address - Country:US
Mailing Address - Phone:561-694-8945
Mailing Address - Fax:561-694-8688
Practice Address - Street 1:601 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-694-8945
Practice Address - Fax:561-694-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065104174400000X
FLME052020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23758Medicare ID - Type Unspecified
FLF73652Medicare UPIN
FL04974Medicare ID - Type Unspecified
FLB99173Medicare UPIN