Organization
PALM BEACH PEDIATRIC UROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES E FLACK M.D. (PRESIDENT)
(561) 512-0614
Entity
Organization
Contact information
Practice address
10301 HAGEN RANCH RD, SUITE C130, BOYNTON BEACH, FL 33437
(561) 736-7313
(561) 736-2309
Mailing address
10301 HAGEN RANCH RD, SUITE C130, BOYNTON BEACH, FL 33437
(561) 736-7313
(561) 736-2309
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
ME599337
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103690
AVMED
FL
01
—
12475
BCBS
FL
01
—
1755943
CIGNA
FL
01
—
2032607
AETNA HMO
FL
01
—
204200
AMERIGROUP
FL
01
—
26943
WELLCARE
FL
05
—
272189900
—
FL
01
—
4611456
AETNA NON-HMO
FL
01
—
5962
NHP
FL
Enumeration date
02/14/2006
Last updated
10/22/2013
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