MEDICARE: DR. DEAN C LOHSE 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	207T00000X	Neurological Surgery Physician	ME0038211	FL

General Provider Information

NPI Number	:	1609837095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN C LOHSE M.D.

Provider Business Mailing Address
First Line	:	3627 UNIVERSITY BLVD S
Second Line	:	SUITE 355
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4230
Country	:	US
Telephone Number	:	904-296-2522
Fax Number	:	904-296-8173

Provider Business Practice Location Address
First Line	:	3627 UNIVERSITY BLVD S
Second Line	:	SUITE 355
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4230
Country	:	US
Telephone Number	:	904-296-2522
Fax Number	:	904-296-8173

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	11/01/2007

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