Provider Demographics
NPI:1356498364
Name:SURGICAL ONCOLOGY OF SOUTH PALM BEACH PA
Entity Type:Organization
Organization Name:SURGICAL ONCOLOGY OF SOUTH PALM BEACH PA
Other - Org Name:SURGICAL ONCOLOGY OF SOUTH PALM BEACH COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PORTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-395-3344
Mailing Address - Street 1:714 COQUINA CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3004
Mailing Address - Country:US
Mailing Address - Phone:561-392-6220
Mailing Address - Fax:
Practice Address - Street 1:875 MEADOWS RD
Practice Address - Street 2:SUITE #331
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2349
Practice Address - Country:US
Practice Address - Phone:561-347-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35565282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00439656OtherRAILROAD MEDICARE
FLAD286OtherMEDICARE GROUP PIN
FLME35565OtherLICENSE
FL95453OtherBLUE CROSS BLUE SHIELD OF FLA
FL039345200Medicaid
FL039345200Medicaid
FLP00439656OtherRAILROAD MEDICARE
FL95453OtherBLUE CROSS BLUE SHIELD OF FLA