Provider Demographics
NPI:1508890153
Name:DANGER, CARLOS R (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:R
Last Name:DANGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 SOUTH MIAMI AVENUE
Mailing Address - Street 2:SUITE 606
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133
Mailing Address - Country:US
Mailing Address - Phone:305-854-9023
Mailing Address - Fax:305-854-9026
Practice Address - Street 1:3661 SOUTH MIAMI AVENUE
Practice Address - Street 2:SUITE 606
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133
Practice Address - Country:US
Practice Address - Phone:305-854-9023
Practice Address - Fax:305-854-9026
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME907752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271815400Medicaid
FL271815400Medicaid
FLU4307AMedicare ID - Type UnspecifiedPROVIDER NUMBER