Healthcare Provider Details

I. General information

NPI: 1194932244
Provider Name (Legal Business Name): DOUGLAS W DAVID D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 NW 33RD AVE SUITE 100
FORT LAUDERDALE FL
33309-6348
US

IV. Provider business mailing address

9690 NW 39TH CT
HOLLYWOOD FL
33024-8063
US

V. Phone/Fax

Practice location:
  • Phone: 954-486-4085
  • Fax: 954-777-5328
Mailing address:
  • Phone: 954-435-7273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberOS5523
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: