1003119173 NPI number — DR.NEAL F.KROUSE, D.O.,P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003119173 NPI number — DR.NEAL F.KROUSE, D.O.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR.NEAL F.KROUSE, D.O.,P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1003119173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2345 W HILLSBORO BLVD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
DEERFIELD BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33442-1110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-418-9445
Provider Business Mailing Address Fax Number:
954-418-9445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2345 W HILLSBORO BLVD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
DEERFIELD BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33442-1110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-418-9445
Provider Business Practice Location Address Fax Number:
954-418-9445
Provider Enumeration Date:
12/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KROUSE
Authorized Official First Name:
NEAL
Authorized Official Middle Name:
FARRELL
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
954-418-9445

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002736700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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