Provider Demographics
NPI:1063500015
Name:DARE, AMOS OLABISI (MD)
Entity type:Individual
Prefix:DR
First Name:AMOS
Middle Name:OLABISI
Last Name:DARE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8185 VIA ANCHO RD
Mailing Address - Street 2:UNIT 880347
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33488
Mailing Address - Country:US
Mailing Address - Phone:561-844-0120
Mailing Address - Fax:904-743-9225
Practice Address - Street 1:544 CESERY BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211
Practice Address - Country:US
Practice Address - Phone:904-743-9222
Practice Address - Fax:904-743-9225
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91254207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271212100Medicaid
FL271212100Medicaid
FLI22027Medicare UPIN