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General NPI Number Information
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NPI Number | 1508015264
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Entity Type | Organization
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Legal Business Name | SOUTH BEACH GYNECOLOGY INC
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Dates
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Enumeration Date | 09/17/2008
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Last Update Date | 10/31/2008
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Provider Practice Location Address
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Address Line | 3900 NW 79TH AVE #575
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City | DORAL
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State | FL
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Zip | 33166-6556
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Country | US
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Telephone | 305-285-6999
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 BRICKELL AVE 2806
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City | MIAMI
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State | FL
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Zip | 33129-2128
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Country | US
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Telephone | 305-285-6999
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | GERALD BRIAN APPLEGATE
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Credential | MD
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Telephone | 305-285-6999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME86206
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License Number State | FL
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