Provider Demographics
NPI:1154307874
Name:BERENGUER, RAMON ALBERTO (MD)
Entity type:Individual
Prefix:
First Name:RAMON
Middle Name:ALBERTO
Last Name:BERENGUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAMON
Other - Middle Name:ALBERTO
Other - Last Name:BERENGUER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6517 TAFT ST STE 102
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4063
Mailing Address - Country:US
Mailing Address - Phone:954-399-9014
Mailing Address - Fax:954-367-7175
Practice Address - Street 1:10650 W STATE ROAD 84 STE 104
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4235
Practice Address - Country:US
Practice Address - Phone:954-399-9014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88240208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2862Medicare ID - Type Unspecified
FLI14642Medicare UPIN