Provider Demographics
NPI:1720068224
Name:STRONG, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:STRONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FOURSTRONG LLC
Mailing Address - Street 2:15841 PINES BLVD. #182
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027
Mailing Address - Country:US
Mailing Address - Phone:954-665-8803
Mailing Address - Fax:954-237-7350
Practice Address - Street 1:FOURSTRONG LLC
Practice Address - Street 2:15841 PINES BLVD. #182
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027
Practice Address - Country:US
Practice Address - Phone:954-665-8803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0083216207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03188OtherBCBS
FL262189400Medicaid
FL03188BMedicare ID - Type UnspecifiedMEDICARE
FL262189400Medicaid