Healthcare Provider Details

I. General information

NPI: 1114254760
Provider Name (Legal Business Name): MR. MARK DANIEL DHOOGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 NE 26TH ST
WILTON MANORS FL
33305-1239
US

IV. Provider business mailing address

819 NE 26TH ST
WILTON MANORS FL
33305-1239
US

V. Phone/Fax

Practice location:
  • Phone: 954-390-7654
  • Fax: 954-390-7618
Mailing address:
  • Phone: 954-390-7654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: