Provider Demographics
NPI:1225339237
Name:DMR PODIATRIC MEDICINE & SURGERY LLC
Entity Type:Organization
Organization Name:DMR PODIATRIC MEDICINE & SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAMEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:754-422-6750
Mailing Address - Street 1:1725 SW 101ST WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6537
Mailing Address - Country:US
Mailing Address - Phone:754-422-6750
Mailing Address - Fax:954-367-7750
Practice Address - Street 1:1725 SW 101 WAY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6537
Practice Address - Country:US
Practice Address - Phone:754-422-6750
Practice Address - Fax:754-367-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3446213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002849500Medicaid