Basic Information
Provider Information
NPI: 1053680520
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GALPERIN
FirstName: TIMUR
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1830 EMBASSY DR
Address2: APT. 313
City: WEST PALM BEACH
State: FL
PostalCode: 334011908
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 13001 SOUTHERN BLVD
Address2:  
City: LOXAHATCHEE
State: FL
PostalCode: 334709203
CountryCode: US
TelephoneNumber: 5617983300
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/29/2011
LastUpdateDate: 12/29/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208D00000XUO2874FLY Allopathic & Osteopathic PhysiciansGeneral Practice 

No ID Information.


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