Healthcare Provider Details

I. General information

NPI: 1104702760
Provider Name (Legal Business Name): ROGER FIMERLUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 GATEWAY BLVD STE 110
BOYNTON BEACH FL
33426-8309
US

IV. Provider business mailing address

3880 NEWPORT AVE
BOYNTON BEACH FL
33436-8529
US

V. Phone/Fax

Practice location:
  • Phone: 561-528-3301
  • Fax: 561-509-0008
Mailing address:
  • Phone: 561-528-3301
  • Fax: 561-509-0008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: