Provider Demographics
NPI:1922396761
Name:STUART B. KROST M.D.P.A.
Entity Type:Organization
Organization Name:STUART B. KROST M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:B
Authorized Official - Last Name:KROST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-296-2220
Mailing Address - Street 1:3618 LANTANA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33462-2246
Mailing Address - Country:US
Mailing Address - Phone:561-296-2220
Mailing Address - Fax:561-296-2221
Practice Address - Street 1:1903 S.E. PORT ST. LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952
Practice Address - Country:US
Practice Address - Phone:561-296-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061951174400000X
FLPA9103862363AM0700X
FLPA9103888363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F20556Medicare UPIN