Provider Demographics
NPI:1336128271
Name:DAUGHTRY EASTRIDGE & KATONA MD PA
Entity Type:Organization
Organization Name:DAUGHTRY EASTRIDGE & KATONA MD PA
Other - Org Name:UROLOGY ASSOCIATES OF THE PALM BEACHES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:EASTRIDGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:561-622-4900
Mailing Address - Street 1:3355 BURNS ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4354
Mailing Address - Country:US
Mailing Address - Phone:561-622-4900
Mailing Address - Fax:561-622-0186
Practice Address - Street 1:3355 BURNS ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4354
Practice Address - Country:US
Practice Address - Phone:561-622-4900
Practice Address - Fax:561-622-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
72051OtherBLUE CROSS
=========OtherUNITED
=========OtherUNITED