Provider Demographics
NPI:1184722993
Name:BOCA UROLOGY PA
Entity type:Organization
Organization Name:BOCA UROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:I
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-394-4500
Mailing Address - Street 1:851 MEADOWS RD
Mailing Address - Street 2:212
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2348
Mailing Address - Country:US
Mailing Address - Phone:561-394-4500
Mailing Address - Fax:561-391-0100
Practice Address - Street 1:851 MEADOWS RD
Practice Address - Street 2:212
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2348
Practice Address - Country:US
Practice Address - Phone:561-394-4500
Practice Address - Fax:561-391-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1138Medicare PIN
FL1146060001Medicare NSC