Provider Demographics
NPI:1487675658
Name:HARBOUR ENT
Entity Type:Organization
Organization Name:HARBOUR ENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:DEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-776-7112
Mailing Address - Street 1:4060 PGA BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6574
Mailing Address - Country:US
Mailing Address - Phone:561-776-7112
Mailing Address - Fax:561-776-7113
Practice Address - Street 1:4060 PGA BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6574
Practice Address - Country:US
Practice Address - Phone:561-776-7112
Practice Address - Fax:561-776-7113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30575174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55843Medicare UPIN
FLK50803Medicare ID - Type Unspecified