Provider Demographics
NPI:1649218561
Name:PALM BEACH NEUROSURGERY LLC
Entity Type:Organization
Organization Name:PALM BEACH NEUROSURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-433-4444
Mailing Address - Street 1:5507 S CONGRESS AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1139
Mailing Address - Country:US
Mailing Address - Phone:561-433-4444
Mailing Address - Fax:561-433-8877
Practice Address - Street 1:5507 S CONGRESS AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1139
Practice Address - Country:US
Practice Address - Phone:561-433-4444
Practice Address - Fax:561-433-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
74721OtherBCBS OF FL
FLK4659Medicare PIN