Provider Demographics
NPI:1003922824
Name:DALGLEISH, FREDERICK A (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:A
Last Name:DALGLEISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2421 NE 65TH ST
Mailing Address - Street 2:#402
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1556
Mailing Address - Country:US
Mailing Address - Phone:954-579-1772
Mailing Address - Fax:954-337-0193
Practice Address - Street 1:3500 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6809
Practice Address - Country:US
Practice Address - Phone:954-239-6060
Practice Address - Fax:954-239-6100
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME88896207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA11905Medicare UPIN