Provider Demographics
NPI:1043712177
Name:PALM BEACH THORACIC SURGERY, PA
Entity type:Organization
Organization Name:PALM BEACH THORACIC SURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN /OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAXMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-766-0834
Mailing Address - Street 1:5162 LINTON BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6567
Mailing Address - Country:US
Mailing Address - Phone:561-766-0834
Mailing Address - Fax:561-948-1682
Practice Address - Street 1:5162 LINTON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6567
Practice Address - Country:US
Practice Address - Phone:561-766-0834
Practice Address - Fax:561-948-1682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99916208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty