Healthcare Provider Details

I. General information

NPI: 1104067222
Provider Name (Legal Business Name): GENERAL SURGERY OF PALM BEACH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3319 STATE ROAD 7 SUITE 207
WELLINGTON FL
33449-8094
US

IV. Provider business mailing address

11101 S CROWN WAY SUITE 1
WELLINGTON FL
33414-8792
US

V. Phone/Fax

Practice location:
  • Phone: 561-753-1101
  • Fax: 561-753-1105
Mailing address:
  • Phone: 561-795-9150
  • Fax: 561-798-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAMARYS PEREZ
Title or Position: OWNER
Credential:
Phone: 561-753-1101