Provider Demographics
NPI:1184731622
Name:HARRY C MIDGLEY III MD PA
Entity type:Organization
Organization Name:HARRY C MIDGLEY III MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MIDGLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:561-346-3469
Mailing Address - Street 1:241 OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-3523
Mailing Address - Country:US
Mailing Address - Phone:561-346-7373
Mailing Address - Fax:561-743-7195
Practice Address - Street 1:3355 BURNS RD STE 104
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4354
Practice Address - Country:US
Practice Address - Phone:561-691-4144
Practice Address - Fax:561-743-7195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39600207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61219Medicare ID - Type Unspecified
C46297Medicare UPIN