Provider Demographics
NPI:1679518559
Name:PALMS WEST PEDIATRIC NEUROSURGERY
Entity type:Organization
Organization Name:PALMS WEST PEDIATRIC NEUROSURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-965-2800
Mailing Address - Street 1:12983 SOUTHERN BLVD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470
Mailing Address - Country:US
Mailing Address - Phone:561-965-2800
Mailing Address - Fax:561-795-2864
Practice Address - Street 1:12983 SOUTHERN BLVD.
Practice Address - Street 2:SUITE 202
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470
Practice Address - Country:US
Practice Address - Phone:561-965-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3753Medicare ID - Type UnspecifiedMEDICARE BCBS