Healthcare Provider Details

I. General information

NPI: 1326019290
Provider Name (Legal Business Name): ROBERT L. DENNISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 819 BOX 18 0022
FPO AE
09645
US

IV. Provider business mailing address

PSC 819 BOX 18 0022
FPO AE
09645
US

V. Phone/Fax

Practice location:
  • Phone: 01134956826342
  • Fax:
Mailing address:
  • Phone: 01134956826342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number026253
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: