Healthcare Provider Details

I. General information

NPI: 1548170657
Provider Name (Legal Business Name): DERWIN GEROD FAIR JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 W PALMETTO PARK RD FL 33433A
BOCA RATON FL
33433-3458
US

IV. Provider business mailing address

4441 NW 70TH AVE
LAUDERHILL FL
33319-4042
US

V. Phone/Fax

Practice location:
  • Phone: 954-248-1171
  • Fax:
Mailing address:
  • Phone: 754-215-5814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-548455
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: