Healthcare Provider Details

I. General information

NPI: 1801359948
Provider Name (Legal Business Name): DENNIS JAMES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2019
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 N ORANGE BLOSSOM TRL
KISSIMMEE FL
34744-2316
US

IV. Provider business mailing address

6101 CREEK DALE CT
ORLANDO FL
32810-3987
US

V. Phone/Fax

Practice location:
  • Phone: 407-846-4343
  • Fax:
Mailing address:
  • Phone: 321-947-5779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME157372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: