Provider Demographics
NPI:1811134273
Name:UNIVERSITY PERINATAL ASSOCIATES
Entity type:Organization
Organization Name:UNIVERSITY PERINATAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUEL
Authorized Official - Middle Name:TYRONE
Authorized Official - Last Name:STOESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:561-630-8001
Mailing Address - Street 1:11505 FAIRCHILD GARDENS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2847
Mailing Address - Country:US
Mailing Address - Phone:561-630-8001
Mailing Address - Fax:
Practice Address - Street 1:11505 FAIRCHILD GARDENS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2847
Practice Address - Country:US
Practice Address - Phone:561-630-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72366207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253207700Medicaid