Healthcare Provider Details

I. General information

NPI: 1295922573
Provider Name (Legal Business Name): STUART B KROST MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3618 LANTANA RD 201
LAKE WORTH FL
33462-2246
US

IV. Provider business mailing address

3618 LANTANA RD 201
LAKE WORTH FL
33462-2246
US

V. Phone/Fax

Practice location:
  • Phone: 561-296-2220
  • Fax: 561-296-1022
Mailing address:
  • Phone: 561-296-2220
  • Fax: 561-296-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9103862
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9103888
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME6195
License Number StateFL

VIII. Authorized Official

Name: STUART B KROST
Title or Position: OWNER
Credential: M.D.
Phone: 561-296-2220