Healthcare Provider Details

I. General information

NPI: 1700822442
Provider Name (Legal Business Name): JUAN D'BROT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 N MILITARY TRL MEDICINE (111)
RIVIERA BEACH FL
33410
US

IV. Provider business mailing address

7305 N MILITARY TRL MEDICINE (111)
RIVIERA BEACH FL
33410-7417
US

V. Phone/Fax

Practice location:
  • Phone: 561-422-6650
  • Fax: 561-422-8708
Mailing address:
  • Phone: 561-422-6650
  • Fax: 561-422-8708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number16418
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number21626
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01077798A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number16418
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number16418
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01077798A
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number61220
License Number StateSC
# 8
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME117965
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: