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General NPI Number Information
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NPI Number | 1164181533
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Entity Type | Organization
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Legal Business Name | PALM VASCULAR CENTER OF CORAL GABLES
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Dates
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Enumeration Date | 12/14/2021
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 2601 SW 37TH AVE STE 704
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City | CORAL GABLES
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State | FL
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Zip | 33133-2750
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Country | US
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Telephone | 305-716-8225
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Fax | 305-716-8234
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Provider Business Mailing Address
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Address Line | 2601 SW 37TH AVE STE 704
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City | CORAL GABLES
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State | FL
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Zip | 33133-2750
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Country | US
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Telephone | 305-716-8225
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Fax | 305-716-8234
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Authorized Official
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Title or Position | CEO
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Name | ERIC ROGERS
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Credential |
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Telephone | 305-716-8225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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