1396211421 NPI number — FLORIDA ATLANTIC UNIVERSITY

Table of content: DR. VAUGHN ERIC DOBALIAN MD (NPI 1245260199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396211421 NPI number — FLORIDA ATLANTIC UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA ATLANTIC UNIVERSITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396211421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 GLADES ROAD
Provider Second Line Business Mailing Address:
COLLEGE OF MEDICINE, BC-71, FINANCE OFFICE
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-566-5328
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 NW 13TH ST STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33486-2342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-297-4814
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2018

Additional Information

Authorized Official

Authorized Official Last Name:
PONTIROLI-KELLY
Authorized Official First Name:
LOUISA
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
561-297-2897

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com