Provider Demographics
NPI:1427041300
Name:MAFDALI, DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:MAFDALI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1379 HARBORVIEW EAST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-5054
Mailing Address - Country:US
Mailing Address - Phone:954-362-4779
Mailing Address - Fax:954-362-4779
Practice Address - Street 1:1379 HARBORVIEW EAST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-5054
Practice Address - Country:US
Practice Address - Phone:954-362-4779
Practice Address - Fax:954-362-4779
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1083213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery