Provider Demographics
NPI:1578514105
Name:ADVANCED UROLOGY ASSOCIATES OF FLORIDA PL
Entity Type:Organization
Organization Name:ADVANCED UROLOGY ASSOCIATES OF FLORIDA PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-562-7220
Mailing Address - Street 1:1986 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2533
Mailing Address - Country:US
Mailing Address - Phone:772-562-7220
Mailing Address - Fax:772-562-5476
Practice Address - Street 1:1986 35TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2533
Practice Address - Country:US
Practice Address - Phone:772-562-7220
Practice Address - Fax:772-562-5476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1OtherNO NUMBER ISSUED YET