Basic Information
| Provider Information | |||||||||
| NPI: | 1164772935 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UROLOGY MEDICAL SPECIALISTS, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5258 LINTON BLVD STE 203 | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334846529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614957570 | ||||||||
| FaxNumber: | 5614967074 | ||||||||
| Practice Location | |||||||||
| Address1: | 4515 WILES RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | COCONUT CREEK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330733414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549431133 | ||||||||
| FaxNumber: | 9547836845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2012 | ||||||||
| LastUpdateDate: | 11/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | GUPTA | ||||||||
| AuthorizedOfficialFirstName: | SANJEEV | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9549431133 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 11/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME105426 | FL | N | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist | 208800000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.