Provider Demographics
NPI:1194790428
Name:DUTRA, MARIA M (PA)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:M
Last Name:DUTRA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:201 NW 82 AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1854
Mailing Address - Country:US
Mailing Address - Phone:954-474-3262
Mailing Address - Fax:954-474-3489
Practice Address - Street 1:8329 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5405
Practice Address - Country:US
Practice Address - Phone:546-271-6179
Practice Address - Fax:954-474-3489
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2019-05-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2551Medicare ID - Type Unspecified
S80610Medicare UPIN