Provider Demographics
NPI:1447371273
Name:LAWRENCE BEROZA MD PA
Entity type:Organization
Organization Name:LAWRENCE BEROZA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEROZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-495-2112
Mailing Address - Street 1:5210 LINTON BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6542
Mailing Address - Country:US
Mailing Address - Phone:561-495-2112
Mailing Address - Fax:561-495-2121
Practice Address - Street 1:5210 LINTON BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6542
Practice Address - Country:US
Practice Address - Phone:561-495-2112
Practice Address - Fax:561-495-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58800Medicare UPIN
79467ZMedicare PIN