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General NPI Number Information
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NPI Number | 1063933505
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Entity Type | Organization
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Legal Business Name | PALM BEACH GENERAL SURGERY AND HERNIA CENTER PLLC
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Dates
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Enumeration Date | 07/06/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3370 BURNS RD STE 100
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4327
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Country | US
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Telephone | 864-546-0353
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Fax |
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Provider Business Mailing Address
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Address Line | 3370 BURNS RD STE 100
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4327
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Country | US
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Telephone | 864-546-0353
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID COYKENDALL
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Credential | DO
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Telephone | 864-546-0353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | OS11700
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License Number State | FL
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