Healthcare Provider Details

I. General information

NPI: 1255310108
Provider Name (Legal Business Name): DAVID MARSHALL KATZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 04/29/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 CONGRESS AVE STE 160
BOCA RATON FL
33487-2861
US

IV. Provider business mailing address

5030 CHAMPION BLVD STE G11-535
BOCA RATON FL
33496-2473
US

V. Phone/Fax

Practice location:
  • Phone: 561-464-5500
  • Fax: 561-464-5501
Mailing address:
  • Phone: 615-464-5500
  • Fax: 614-645-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD 039970 E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberME102631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: