Provider Demographics
NPI:1245297027
Name:UROLOGY CONSULTANTS OF SOUTH PALM
Entity type:Organization
Organization Name:UROLOGY CONSULTANTS OF SOUTH PALM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-381-7773
Mailing Address - Street 1:13590 S JOG RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3807
Mailing Address - Country:US
Mailing Address - Phone:561-381-7773
Mailing Address - Fax:561-381-7774
Practice Address - Street 1:13590 JOG RD
Practice Address - Street 2:SUITE #2
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3807
Practice Address - Country:US
Practice Address - Phone:561-381-7773
Practice Address - Fax:561-381-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9473Medicare PIN