Provider Demographics
NPI:1316272297
Name:BERUBE, MARCEL JOSEPH JR (PT)
Entity type:Individual
Prefix:MR
First Name:MARCEL
Middle Name:JOSEPH
Last Name:BERUBE
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SW 128TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33325-2303
Mailing Address - Country:US
Mailing Address - Phone:954-723-9333
Mailing Address - Fax:
Practice Address - Street 1:113 SW 128TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33325-2303
Practice Address - Country:US
Practice Address - Phone:954-723-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11909174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist