Healthcare Provider Details

I. General information

NPI: 1275569675
Provider Name (Legal Business Name): D AND E SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4620 N HIATUS RD
SUNRISE FL
33351-7909
US

IV. Provider business mailing address

4620 N HIATUS RD
SUNRISE FL
33351-7909
US

V. Phone/Fax

Practice location:
  • Phone: 954-747-5531
  • Fax: 954-572-2899
Mailing address:
  • Phone: 954-747-5531
  • Fax: 954-572-2899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1312768
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number1312768
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number1312768
License Number StateFL

VIII. Authorized Official

Name: MR. BRIAN M GORDON
Title or Position: PRESIDENT
Credential: J.D.
Phone: 954-747-5531