Healthcare Provider Details

I. General information

NPI: 1184775652
Provider Name (Legal Business Name): BIERUT DAREN FAMILY MEDICINE WALK-IN CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10308 W SAMPLE RD
CORAL SPRINGS FL
33065-3942
US

IV. Provider business mailing address

10308 W SAMPLE RD
CORAL SPRINGS FL
33065-3942
US

V. Phone/Fax

Practice location:
  • Phone: 954-755-4880
  • Fax: 954-755-0861
Mailing address:
  • Phone: 954-755-4880
  • Fax: 954-755-0861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS8245
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. ROBERT DAREN
Title or Position: PRESIDENT
Credential: PA-C
Phone: 954-755-4880