Healthcare Provider Details

I. General information

NPI: 1245768217
Provider Name (Legal Business Name): AVIRAM ASSIDON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 FORUM PL STE 101
WEST PALM BEACH FL
33401-8102
US

IV. Provider business mailing address

1601 FORUM PL STE 101
WEST PALM BEACH FL
33401-8102
US

V. Phone/Fax

Practice location:
  • Phone: 561-455-1355
  • Fax: 332-210-7679
Mailing address:
  • Phone: 561-455-1355
  • Fax: 332-210-7679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME166187
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: