Healthcare Provider Details

I. General information

NPI: 1811134273
Provider Name (Legal Business Name): UNIVERSITY PERINATAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11505 FAIRCHILD GARDENS AVE SUITE 101
PALM BEACH GARDENS FL
33410-2847
US

IV. Provider business mailing address

11505 FAIRCHILD GARDENS AVE SUITE 101
PALM BEACH GARDENS FL
33410-2847
US

V. Phone/Fax

Practice location:
  • Phone: 561-630-8001
  • Fax:
Mailing address:
  • Phone: 561-630-8001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberME72366
License Number StateFL

VIII. Authorized Official

Name: DR. RUEL TYRONE STOESSEL
Title or Position: OWNER
Credential: M.D., P.A.
Phone: 561-630-8001