Provider Demographics
NPI:1427393800
Name:LEE A GIBSTEIN MD PA
Entity Type:Organization
Organization Name:LEE A GIBSTEIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIBSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-865-2802
Mailing Address - Street 1:10075 S JOG RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3535
Mailing Address - Country:US
Mailing Address - Phone:561-731-4900
Mailing Address - Fax:561-731-4419
Practice Address - Street 1:1111 KANE CONCOURSE
Practice Address - Street 2:SUITE 311
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2029
Practice Address - Country:US
Practice Address - Phone:305-865-2802
Practice Address - Fax:305-865-9257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty