Provider Demographics
NPI:1841422581
Name:PALM HARBOR ORTHOPEDICS PA
Entity Type:Organization
Organization Name:PALM HARBOR ORTHOPEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BATHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-586-2234
Mailing Address - Street 1:PO BOX 352077
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32135-2077
Mailing Address - Country:US
Mailing Address - Phone:386-586-2234
Mailing Address - Fax:386-586-2884
Practice Address - Street 1:80 PINNACLES DR
Practice Address - Street 2:SUITE 700
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2323
Practice Address - Country:US
Practice Address - Phone:386-586-2234
Practice Address - Fax:386-586-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME004566207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty