Provider Demographics
NPI:1932287323
Name:DERAY, MARCEL J (MD)
Entity Type:Individual
Prefix:
First Name:MARCEL
Middle Name:J
Last Name:DERAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SW 60TH CT STE 302
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4071
Mailing Address - Country:US
Mailing Address - Phone:305-662-8330
Mailing Address - Fax:305-663-2813
Practice Address - Street 1:3200 SW 60 CT
Practice Address - Street 2:STE #302
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33153
Practice Address - Country:US
Practice Address - Phone:305-662-8330
Practice Address - Fax:305-663-2813
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00424072084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041979600Medicaid
FL964134Medicare ID - Type Unspecified