Provider Demographics
NPI:1710901376
Name:ADVANCED UROLOGY OF SOUTH FLORIDA, LLC
Entity Type:Organization
Organization Name:ADVANCED UROLOGY OF SOUTH FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:YORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-496-1111
Mailing Address - Street 1:5350 W. ATLANTIC AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6596
Mailing Address - Country:US
Mailing Address - Phone:561-496-4444
Mailing Address - Fax:561-496-2001
Practice Address - Street 1:5350 W. ATLANTICE AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6596
Practice Address - Country:US
Practice Address - Phone:561-496-4444
Practice Address - Fax:561-496-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2006-22866208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5831180001Medicare NSC