Provider Demographics
NPI:1285895763
Name:LOWER KEYS UROLOGY PLLC
Entity type:Organization
Organization Name:LOWER KEYS UROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FARISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-296-0000
Mailing Address - Street 1:3714 N ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4533
Mailing Address - Country:US
Mailing Address - Phone:305-296-0000
Mailing Address - Fax:305-296-0002
Practice Address - Street 1:3714 N ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4533
Practice Address - Country:US
Practice Address - Phone:305-296-0000
Practice Address - Fax:305-296-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL483Medicare PIN