MEDICARE: DEAN BOYD HILDAHL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	ME72896	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	41706	OTHER	FL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518916642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEAN BOYD HILDAHL M.D.

Provider Business Mailing Address
First Line	:	6610 WILLOW PARK DRIVE
Second Line	:	SUITE 102
City	:	NAPLES
State	:	FL
Zip	:	34109-0921
Country	:	US
Telephone Number	:	239-593-5510
Fax Number	:	239-593-5414

Provider Business Practice Location Address
First Line	:	1865 VETERANS PARK DR STE 201
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-0447
Country	:	US
Telephone Number	:	239-593-5510
Fax Number	:	239-593-5414

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	05/19/2022

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