MEDICARE: EAST ATLANTIC SURGICAL GROUP, INC

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1285154286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST ATLANTIC SURGICAL GROUP, INC

Provider Business Mailing Address
First Line	:	5130 LINTON BLVD STE G
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6596
Country	:	US
Telephone Number	:	561-330-4695
Fax Number	:

Provider Business Practice Location Address
First Line	:	5130 LINTON BLVD
Second Line	:	SUITE G
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-4566
Country	:	US
Telephone Number	:	561-330-4695
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EUGENIO RODRIGUEZ
Credential	:	MD
Telephone Number	:	561-330-4695

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	07/21/2022

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