=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194775759
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALM BEACH NEUROSURGERY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2006
-----------------------------------------------------
Last Update Date | 07/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4560 LANTANA RD STE 120
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33463-6998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-433-4444
-----------------------------------------------------
Fax | 561-433-8877
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4560 LANTANA RD STE 120
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33463-6998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-433-4444
-----------------------------------------------------
Fax | 561-433-8877
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | DR. STEVEN A DUTCHER
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 561-433-4444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------