Healthcare Provider Details

I. General information

NPI: 1669480208
Provider Name (Legal Business Name): UROLOGY CENTER OF SOUTH FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 ENTERPRISE CENTER BLVD SUITE 201
BOYNTON BEACH FL
33437-3759
US

IV. Provider business mailing address

10151 ENTERPRISE CENTER BLVD SUITE 201
BOYNTON BEACH FL
33437-3759
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-9191
  • Fax: 561-733-9145
Mailing address:
  • Phone: 561-737-9191
  • Fax: 561-733-9145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT GARY GOLD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-737-9191