Healthcare Provider Details

I. General information

NPI: 1134107691
Provider Name (Legal Business Name): SOUTH PALM BEACH NEPHROLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 11/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5503 S CONGRESS AVE SUITE 103
ATLANTIS FL
33462-6625
US

IV. Provider business mailing address

5503 S CONGRESS AVE SUITE 103
ATLANTIS FL
33462-6625
US

V. Phone/Fax

Practice location:
  • Phone: 561-965-7228
  • Fax: 561-965-0120
Mailing address:
  • Phone: 561-965-7228
  • Fax: 561-965-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME 70882
License Number StateFL

VIII. Authorized Official

Name: DAVID HALPERT
Title or Position: PARTNER
Credential: M.D.
Phone: 561-965-7228