Healthcare Provider Details

I. General information

NPI: 1598717175
Provider Name (Legal Business Name): MICHAEL A DENNIS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD BOX 100247
GAINESVILLE FL
32610-0247
US

IV. Provider business mailing address

PO BOX 100247
GAINESVILLE FL
32610-0247
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6815
  • Fax: 352-273-7515
Mailing address:
  • Phone: 352-273-6815
  • Fax: 352-273-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME 27186
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: