Provider Demographics
NPI:1982867016
Name:D & D MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:D & D MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:DE JESUS
Authorized Official - Last Name:DALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-275-7373
Mailing Address - Street 1:7650 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2406
Mailing Address - Country:US
Mailing Address - Phone:305-275-7373
Mailing Address - Fax:305-275-7066
Practice Address - Street 1:7650 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2406
Practice Address - Country:US
Practice Address - Phone:305-269-8099
Practice Address - Fax:305-261-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8691Medicare PIN