Healthcare Provider Details

I. General information

NPI: 1548321599
Provider Name (Legal Business Name): JUSTIN CALVERT KEARSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/14/2020
Certification Date: 06/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 SOUTHERN BLVD STE 100
WEST PALM BEACH FL
33411-3803
US

IV. Provider business mailing address

4215 BURNS RD STE 200
PALM BEACH GARDENS FL
33410-4625
US

V. Phone/Fax

Practice location:
  • Phone: 561-694-7776
  • Fax: 561-694-3099
Mailing address:
  • Phone: 561-694-7776
  • Fax: 561-694-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberME112387
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: