MEDICARE: IVAN F. DANGER PHD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY4468	FL

General Provider Information

NPI Number	:	1700292372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVAN F. DANGER PHD PA

Provider Business Mailing Address
First Line	:	1801 SW 22ND ST STE 405
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-2784
Country	:	US
Telephone Number	:	305-854-9023
Fax Number	:	305-854-9026

Provider Business Practice Location Address
First Line	:	1801 SW 22ND ST STE 405
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-2784
Country	:	US
Telephone Number	:	305-854-9023
Fax Number	:	305-854-9026

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	IVAN F DANGER
Credential	:	PHD
Telephone Number	:	305-854-9023

Provider Enumeration Date	:	07/03/2014
Last Update Date	:	07/03/2014

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