Provider Demographics
NPI:1508923046
Name:DALUS, EDDY (LMT)
Entity Type:Individual
Prefix:
First Name:EDDY
Middle Name:
Last Name:DALUS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4816 NW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-3956
Mailing Address - Country:US
Mailing Address - Phone:954-383-9430
Mailing Address - Fax:
Practice Address - Street 1:2713 N ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33311-2511
Practice Address - Country:US
Practice Address - Phone:954-568-5252
Practice Address - Fax:954-568-6833
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA26581246Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA26581OtherLICENSE NUMBER