Provider Demographics
NPI:1609862002
Name:DEAKTER, DANIEL ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBERT
Last Name:DEAKTER
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 1:7666 CYPRESS CRES
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4109
Mailing Address - Country:US
Mailing Address - Phone:561-245-1363
Mailing Address - Fax:561-892-7640
Practice Address - Street 1:7035 BERACASA WAY STE 104
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:561-501-1572
Practice Address - Fax:561-892-7640
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA307816207P00000X
TXR1012207P00000X
PAMD025727E207P00000X
FLME32665207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D63106Medicare UPIN
94055NMedicare PIN