=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245297027
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UROLOGY CONSULTANTS OF SOUTH PALM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2006
-----------------------------------------------------
Last Update Date | 06/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13590 JOG RD SUITE #2
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33446-3807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-381-7773
-----------------------------------------------------
Fax | 561-381-7774
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13590 S JOG RD SUITE #2
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33446-3807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-381-7773
-----------------------------------------------------
Fax | 561-381-7774
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | SHEILA GILBERRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-381-7773
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------