Provider Demographics
NPI:1891804696
Name:TAUB, DAVID ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:TAUB
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 1:701 NW 13TH ST
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2305
Mailing Address - Country:US
Mailing Address - Phone:561-955-5790
Mailing Address - Fax:561-955-5791
Practice Address - Street 1:701 NW 13TH ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2305
Practice Address - Country:US
Practice Address - Phone:561-955-5790
Practice Address - Fax:561-955-5791
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35089293208800000X
FLME106726208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00429538OtherRAILROAD MEDICARE
OH2754621Medicaid
OH0189180001Medicare NSC
OHP00429538OtherRAILROAD MEDICARE
FLDD208YMedicare PIN
OH4207401Medicare PIN