Provider Demographics
NPI:1437145653
Name:GULFSTREAM UROLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:GULFSTREAM UROLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-465-2020
Mailing Address - Street 1:579 NW LAKE WHITNEY PL STE 105
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1622
Mailing Address - Country:US
Mailing Address - Phone:772-465-2020
Mailing Address - Fax:772-465-2111
Practice Address - Street 1:579 NW LAKE WHITNEY PL STE 105
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1622
Practice Address - Country:US
Practice Address - Phone:772-465-2020
Practice Address - Fax:772-465-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88543208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI39566Medicare UPIN
FLI05982Medicare UPIN
FL28779ZMedicare ID - Type UnspecifiedDR. VAN APPLEDORN
FLU5040ZMedicare ID - Type UnspecifiedDR. ADAM BALL
FLK7900Medicare ID - Type UnspecifiedGROUP MEDICARE ID