Healthcare Provider Details

I. General information

NPI: 1467434720
Provider Name (Legal Business Name): DANIEL A DENNIS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOBILE INFIRMARY CIR
MOBILE AL
36607-3513
US

IV. Provider business mailing address

50B MIDTOWN PARK W
MOBILE AL
36606-4148
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-5114
  • Fax:
Mailing address:
  • Phone: 251-435-5114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number10944
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: