Healthcare Provider Details

I. General information

NPI: 1255759601
Provider Name (Legal Business Name): MARC DAUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 W BROWARD BLVD STE 200
FORT LAUDERDALE FL
33312-1420
US

IV. Provider business mailing address

2307 W BROWARD BLVD STE 200
FORT LAUDERDALE FL
33312-1420
US

V. Phone/Fax

Practice location:
  • Phone: 954-906-0591
  • Fax:
Mailing address:
  • Phone: 954-906-0591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME144906
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: