Provider Demographics
NPI:1013422054
Name:FLORIDA UROLOGY ASSOCIATES INC
Entity type:Organization
Organization Name:FLORIDA UROLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARGAROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-876-5649
Mailing Address - Street 1:240 W INDIANTOWN RD STE 107
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3548
Mailing Address - Country:US
Mailing Address - Phone:561-876-5649
Mailing Address - Fax:561-962-1551
Practice Address - Street 1:240 W INDIANTOWN RD STE 107
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3548
Practice Address - Country:US
Practice Address - Phone:561-876-5649
Practice Address - Fax:561-962-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126486208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023970300Medicaid