MEDICARE: STUART B KROST MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9103862	FL
2	363AM0700X	Medical Physician Assistant	PA9103888	FL
3	174400000X	Specialist	ME6195	FL

General Provider Information

NPI Number	:	1295922573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STUART B KROST MD PA

Provider Business Mailing Address
First Line	:	3618 LANTANA RD
Second Line	:	201
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-2246
Country	:	US
Telephone Number	:	561-296-2220
Fax Number	:	561-296-1022

Provider Business Practice Location Address
First Line	:	3618 LANTANA RD
Second Line	:	201
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-2246
Country	:	US
Telephone Number	:	561-296-2220
Fax Number	:	561-296-1022

Authorized Official
Title or Position	:	OWNER
Name	:	STUART B KROST
Credential	:	M.D.
Telephone Number	:	561-296-2220

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	12/02/2011

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