Basic Information
| Provider Information | |||||||||
| NPI: | 1205377587 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OBGYN SPECIALISTS OF THE PALM BEACHES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 770 NORTHPOINT PARKWAY | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334071901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612757604 | ||||||||
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| Practice Location | |||||||||
| Address1: | 901 NORTHPOINT PKWY | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334071951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616232800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2017 | ||||||||
| LastUpdateDate: | 09/25/2017 | ||||||||
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| AuthorizedOfficialLastName: | BURIGO | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5612757509 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 372700918 | 05 | FL | MEDICAID |