1508837725 NPI number — MR. EUGENE A MISQUITH MD PA

Table of content: MR. EUGENE A MISQUITH MD PA (NPI 1508837725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508837725 NPI number — MR. EUGENE A MISQUITH MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MISQUITH
Provider First Name:
EUGENE
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508837725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 530396
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33403-8906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-351-7710
Provider Business Mailing Address Fax Number:
855-205-7185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 45TH ST
Provider Second Line Business Practice Location Address:
ST MARYS HOSPITAL
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33407-2413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-844-6300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0127X , with the licence number:  ME58715 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 064645800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009328100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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