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General NPI Number Information
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NPI Number | 1194841122
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Entity Type | Individual
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Provider Name | DWIGHT DWAIN HOARAU M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 1055 SAXON BLVD
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City | ORANGE CITY
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State | FL
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Zip | 32763-8468
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Country | US
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Telephone | 386-917-5526
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Fax | 386-917-5553
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Provider Business Mailing Address
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Address Line | 1055 SAXON BLVD
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City | ORANGE CITY
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State | FL
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Zip | 32763-8468
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Country | US
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Telephone | 386-917-5526
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Fax | 386-917-5553
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101235995
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME98352
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License Number State | FL
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