Doctor Name: | DAVID BLYWEISS |
NPI Number: | 1669659694 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | ME42858 |
Business Practice Address: | 100 Se 15th Ave Fort Lauderdale, FL - 333013908 |
Business Phone Number: | 9547631230 |
Business Fax Number: | |
Mailing Address: | 100 Se 15th Avenue, FORT LAUDERDALE |
State: | FL |
Postal Code: | 33301 |
Phone Number: | 9547631230 |
Fax Number: | |
NPI Enumeration Date: | 01/22/2008 |
NPI Last Update Date: | 01/22/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME42858 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |