MEDICARE: UROLOGY CONSULTANTS OF SOUTH PALM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician

General Provider Information

NPI Number	:	1245297027
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UROLOGY CONSULTANTS OF SOUTH PALM

Provider Business Mailing Address
First Line	:	13590 S JOG RD
Second Line	:	SUITE #2
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-3807
Country	:	US
Telephone Number	:	561-381-7773
Fax Number	:	561-381-7774

Provider Business Practice Location Address
First Line	:	13590 JOG RD
Second Line	:	SUITE #2
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-3807
Country	:	US
Telephone Number	:	561-381-7773
Fax Number	:	561-381-7774

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SHEILA GILBERRY
Credential	:
Telephone Number	:	561-381-7773

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	06/18/2008

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Practice Location Address:

13590 JOG RD , SUITE C3
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33446-3807

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1700859048 — REBELLO MEDICAL ASSOCIATES MD PL
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1902879950 — DR. VERNON REBELLO M.D.
Practice Location Address:

13590 JOG RD , SUITE C3
DELRAY BEACH, FL
33446-3807

Practice Phone: 561-637-8383
Practice Fax: 561-423-9253

1093783086 — DR. MARC DAVID GOLDEN D.O.
Practice Location Address:

13590 JOG RD , SUITE 7
DELRAY BEACH, FL
33446-3807

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1104882240 — DR. RONALD L COHEN M.D.
Practice Location Address:

13590 S JOG RD , STE 2
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1548228729 — DR. BRUCE WILLIAM ZUKERBERG M.D
Practice Location Address:

13590 JOG RD , STE 4-5
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Practice Phone: 561-496-0833
Practice Fax:

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