MEDICARE: PALM BEACH PLASTIC SURGERY INSTITUTE, P.A

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	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1316627441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM BEACH PLASTIC SURGERY INSTITUTE, P.A

Provider Business Mailing Address
First Line	:	1411 N FLAGLER DR STE 6400
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3425
Country	:	US
Telephone Number	:	561-800-3223
Fax Number	:	561-879-9388

Provider Business Practice Location Address
First Line	:	1411 N FLAGLER DR STE 6400
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3425
Country	:	US
Telephone Number	:	561-800-3223
Fax Number	:	561-879-9388

Authorized Official
Title or Position	:	OWNER
Name	:	EDWARD DAVIDSON
Credential	:	MD
Telephone Number	:	561-800-3223

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	11/18/2023

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