Healthcare Provider Details

I. General information

NPI: 1518167451
Provider Name (Legal Business Name): LIAT NADAV DAGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 NW 13TH ST FL 2
BOCA RATON FL
33486-2305
US

IV. Provider business mailing address

6282 LINTON BLVD
DELRAY BEACH FL
33484-6416
US

V. Phone/Fax

Practice location:
  • Phone: 561-955-6400
  • Fax: 561-955-6618
Mailing address:
  • Phone: 561-495-8307
  • Fax: 561-495-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME105551
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number105551
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number105551
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: