Provider Demographics
NPI:1740277201
Name:FIELDS, CONSTANCE DARYL (MD)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:DARYL
Last Name:FIELDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9980 CENTRAL PARK BLVD N
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1762
Mailing Address - Country:US
Mailing Address - Phone:561-483-8335
Mailing Address - Fax:561-451-8122
Practice Address - Street 1:9980 CENTRAL PARK BLVD N
Practice Address - Street 2:SUITE 304
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1762
Practice Address - Country:US
Practice Address - Phone:561-483-8335
Practice Address - Fax:561-451-8122
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56883207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE36024Medicare UPIN
18450YMedicare PIN