Basic Information
| Provider Information | |||||||||
| NPI: | 1790747319 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS TO WOMEN PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1815 S KANNER HWY | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34994 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722882992 | ||||||||
| FaxNumber: | 7722882999 | ||||||||
| Practice Location | |||||||||
| Address1: | 1815 S KANNER HWY | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34994 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722882992 | ||||||||
| FaxNumber: | 7722882999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 08/23/2012 | ||||||||
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| AuthorizedOfficialLastName: | HOCHMAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | HENRY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7722882992 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | ME0062227 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
ID Information
| ID | Type | State | Issuer | Description | 72849 | 01 | BCBS | OTHER | 373034400 | 05 | FL | MEDICAID |