Provider Demographics
NPI:1114098753
Name:SOUTH PALM PLASTIC SURGERY ASSOCIATES, P.L.
Entity Type:Organization
Organization Name:SOUTH PALM PLASTIC SURGERY ASSOCIATES, P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:DARDANO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-361-0065
Mailing Address - Street 1:1000 NW 9TH CT
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2268
Mailing Address - Country:US
Mailing Address - Phone:561-361-0065
Mailing Address - Fax:561-347-1945
Practice Address - Street 1:1000 NW 9TH CT
Practice Address - Street 2:SUITE 202
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2268
Practice Address - Country:US
Practice Address - Phone:561-361-0065
Practice Address - Fax:561-347-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7441208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35417Medicare ID - Type Unspecified
FLF80268Medicare UPIN