Basic Information
| Provider Information | |||||||||
| NPI: | 1306490008 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | G34 SURGICAL ASSOCIATES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1155 S CONGRESS AVE STE C | ||||||||
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| City: | PALM SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334065114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617661300 | ||||||||
| FaxNumber: | 5616930539 | ||||||||
| Practice Location | |||||||||
| Address1: | 241 SE 1ST ST | ||||||||
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| City: | BELLE GLADE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334303501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617079149 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2019 | ||||||||
| LastUpdateDate: | 11/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | BARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5617079149 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 11/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.