Organization
T. D. MEDICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS EDWARD SHERRON ATP (PRESIDENT)
(954) 921-9099
Entity
Organization
Contact information
Practice address
208 CALLE MENDEZ VIGO W, MAYAGUEZ, PR 00682-3234
(787) 652-3683
(787) 652-3680
Mailing address
3200 N 29TH AVE, HOLLYWOOD, FL 33020-1313
(954) 921-9099
(954) 921-1937
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
15747-F
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209238700
—
FL
05
—
209238779
—
FL
05
—
672210596
—
FL
Enumeration date
05/12/2015
Last updated
12/01/2017
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