Healthcare Provider Details

I. General information

NPI: 1619137320
Provider Name (Legal Business Name): CARL JOSHUA DANZIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 W SAMPLE RD
POMPANO BEACH FL
33064
US

IV. Provider business mailing address

5 W SAMPLE RD
POMPANO BEACH FL
33064-3542
US

V. Phone/Fax

Practice location:
  • Phone: 954-782-1700
  • Fax:
Mailing address:
  • Phone: 215-630-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberN2461
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME109536
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME109536
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: