Provider Demographics
NPI:1508837725
Name:MISQUITH, EUGENE A (MD PA)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:A
Last Name:MISQUITH
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 530396
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-8906
Mailing Address - Country:US
Mailing Address - Phone:561-351-7710
Mailing Address - Fax:855-205-7185
Practice Address - Street 1:901 45TH ST
Practice Address - Street 2:ST MARYS HOSPITAL
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2413
Practice Address - Country:US
Practice Address - Phone:561-844-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME587152086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064645800Medicaid
FL009328100Medicaid
E66539Medicare UPIN
FL009328100Medicaid