Healthcare Provider Details

I. General information

NPI: 1700724127
Provider Name (Legal Business Name): ALEXIS MARIE DETTRICH FELGENTRAGER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 BOATNER RD
EGLIN AFB FL
32542-1302
US

IV. Provider business mailing address

833 TANAGER RD
FORT WALTON BEACH FL
32547-1229
US

V. Phone/Fax

Practice location:
  • Phone: 850-883-8288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: