Provider Demographics
NPI: | 1467751982 |
---|---|
Name: | IVAN DANGER PHD PA |
Entity Type: | Organization |
Organization Name: | IVAN DANGER PHD PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | IVAN |
Authorized Official - Middle Name: | F |
Authorized Official - Last Name: | DANGER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD |
Authorized Official - Phone: | 305-274-9755 |
Mailing Address - Street 1: | 9370 SUNSET DR |
Mailing Address - Street 2: | SUITE A240 |
Mailing Address - City: | MIAMI |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33173-5431 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-274-9755 |
Mailing Address - Fax: | 305-274-4137 |
Practice Address - Street 1: | 9370 SUNSET DR |
Practice Address - Street 2: | SUITE A240 |
Practice Address - City: | MIAMI |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33173-5431 |
Practice Address - Country: | US |
Practice Address - Phone: | 305-274-9755 |
Practice Address - Fax: | 305-274-4137 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-03-23 |
Last Update Date: | 2017-02-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 73812 | Medicare PIN |