Healthcare Provider Details

I. General information

NPI: 1619943669
Provider Name (Legal Business Name): EDWARD STEPHEN KRIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S SEACREST BLVD SUITE 150
BOYNTON BEACH FL
33435-7961
US

IV. Provider business mailing address

2800 S SEACREST BLVD SUITE 150
BOYNTON BEACH FL
33435-7961
US

V. Phone/Fax

Practice location:
  • Phone: 561-734-1888
  • Fax:
Mailing address:
  • Phone: 561-734-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME71114
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: