Healthcare Provider Details

I. General information

NPI: 1851536221
Provider Name (Legal Business Name): STUART UROLOGY P.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2398 SE OCEAN BLVD SUITE B
STUART FL
34996-3310
US

IV. Provider business mailing address

2398 SE OCEAN BLVD SUITE B
STUART FL
34996-3310
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-2864
  • Fax: 772-223-2875
Mailing address:
  • Phone: 772-223-2864
  • Fax: 772-223-2875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTONIO J BELTRAN
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 772-223-2864