Healthcare Provider Details

I. General information

NPI: 1023197886
Provider Name (Legal Business Name): DEBERENIA ELIZABETH ALLEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140A S FEDERAL HWY
DANIA FL
33004-3623
US

IV. Provider business mailing address

1119 E TROPICAL WAY
PLANTATION FL
33317-3343
US

V. Phone/Fax

Practice location:
  • Phone: 954-922-7606
  • Fax: 954-922-6898
Mailing address:
  • Phone: 954-583-8066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME69884
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: