Provider Demographics
NPI:1053879338
Name:DANIEL R. DEAKTER, M.D.PA
Entity type:Organization
Organization Name:DANIEL R. DEAKTER, M.D.PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DEAKTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-245-1363
Mailing Address - Street 1:7035 BERACASA WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3454
Mailing Address - Country:US
Mailing Address - Phone:561-501-1572
Mailing Address - Fax:
Practice Address - Street 1:7035 BERACASA WAY STE 104
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3454
Practice Address - Country:US
Practice Address - Phone:561-501-1572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care