Provider Demographics
NPI:1457739237
Name:T. D. MEDICAL, INC.
Entity Type:Organization
Organization Name:T. D. MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SHERRON
Authorized Official - Suffix:
Authorized Official - Credentials:ATP
Authorized Official - Phone:954-921-9099
Mailing Address - Street 1:3200 N 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-1313
Mailing Address - Country:US
Mailing Address - Phone:954-921-9099
Mailing Address - Fax:954-921-1937
Practice Address - Street 1:208 CALLE MENDEZ VIGO W
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-3234
Practice Address - Country:US
Practice Address - Phone:787-652-3683
Practice Address - Fax:787-652-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15747-F332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL209238779Medicaid
FL209238700Medicaid
FL672210596Medicaid
FL209238779Medicaid