Healthcare Provider Details

I. General information

NPI: 1356498364
Provider Name (Legal Business Name): SURGICAL ONCOLOGY OF SOUTH PALM BEACH PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 MEADOWS RD SUITE #331
BOCA RATON FL
33486-2349
US

IV. Provider business mailing address

714 COQUINA CT
BOCA RATON FL
33432-3004
US

V. Phone/Fax

Practice location:
  • Phone: 561-347-5656
  • Fax:
Mailing address:
  • Phone: 561-392-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberME35565
License Number StateFL

VIII. Authorized Official

Name: DR. LEE ALAN PORTERFIELD
Title or Position: OWNER
Credential: M.D.
Phone: 561-395-3344