Healthcare Provider Details

I. General information

NPI: 1922396761
Provider Name (Legal Business Name): STUART B. KROST M.D.P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 S.E. PORT ST. LUCIE BLVD
PORT ST. LUCIE FL
34952
US

IV. Provider business mailing address

3618 LANTANA RD SUITE 201
LAKE WORTH FL
33462-2246
US

V. Phone/Fax

Practice location:
  • Phone: 561-296-2220
  • Fax:
Mailing address:
  • Phone: 561-296-2220
  • Fax: 561-296-2221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9103888
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9103862
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0061951
License Number StateFL

VIII. Authorized Official

Name: STUART B KROST
Title or Position: OWNER
Credential: MD
Phone: 561-296-2220