Healthcare Provider Details

I. General information

NPI: 1699040790
Provider Name (Legal Business Name): ETAN DAYAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3848 FAU BLVD
BOCA RATON FL
33431-6437
US

IV. Provider business mailing address

3848 FAU BLVD
BOCA RATON FL
33431-6437
US

V. Phone/Fax

Practice location:
  • Phone: 561-455-3627
  • Fax:
Mailing address:
  • Phone: 561-455-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME157673
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: