Provider Demographics
NPI:1699812560
Name:STRAW, DOROTHY VIOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:VIOLA
Last Name:STRAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 NW 3RD CT
Mailing Address - Street 2:STE 110
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2813
Mailing Address - Country:US
Mailing Address - Phone:954-584-8222
Mailing Address - Fax:954-584-8224
Practice Address - Street 1:4100 S HOSPITAL DR
Practice Address - Street 2:STE 110
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2813
Practice Address - Country:US
Practice Address - Phone:954-584-8222
Practice Address - Fax:954-584-8224
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045637208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94615OtherBLUE CROSS
FL008241OtherAV MED PROVIDER NUMBER
FL14138OtherSTAYWELL PROVIDER
FL260658500Medicaid
FL94615OtherBLUE CROSS
FL260658500Medicaid