Provider Demographics
NPI:1831143312
Name:KROST, STUART BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:BRUCE
Last Name:KROST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10394 LA REINA RD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2723
Mailing Address - Country:US
Mailing Address - Phone:561-496-3743
Mailing Address - Fax:
Practice Address - Street 1:3618 LANTANA RD
Practice Address - Street 2:ST. #201
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-2246
Practice Address - Country:US
Practice Address - Phone:561-296-2221
Practice Address - Fax:561-296-2221
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14950Medicare ID - Type Unspecified
FLF20556Medicare UPIN