Healthcare Provider Details

I. General information

NPI: 1962785683
Provider Name (Legal Business Name): MARTIN DAYTON, DO, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18600 COLLINS AVENUE
SUNNY ISLES BEACH FL
33160
US

IV. Provider business mailing address

18600 COLLINS AVENUE
SUNNY ISLES BEACH FL
33160-2426
US

V. Phone/Fax

Practice location:
  • Phone: 305-931-8484
  • Fax: 305-936-1849
Mailing address:
  • Phone: 305-931-8484
  • Fax: 305-936-1849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MARTIN DAYTON
Title or Position: PRESIDENT
Credential: D.O.
Phone: 305-931-8484