Provider Demographics
NPI:1801015177
Name:PALM BEACH GENERAL SURGERY LLC
Entity Type:Organization
Organization Name:PALM BEACH GENERAL SURGERY LLC
Other - Org Name:JFK MEDICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-548-3821
Mailing Address - Street 1:5511 S CONGRESS AVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1140
Mailing Address - Country:US
Mailing Address - Phone:561-548-3716
Mailing Address - Fax:
Practice Address - Street 1:5511 S CONGRESS AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1140
Practice Address - Country:US
Practice Address - Phone:561-548-3716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93782207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC12244Medicare UPIN