Healthcare Provider Details

I. General information

NPI: 1326009952
Provider Name (Legal Business Name): REGINALD C DEAN IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7119 LANGLEY ST NAVAL BRANCH HEALTH CLINIC WHITING FIELD
MILTON FL
32570-6105
US

IV. Provider business mailing address

7119 LANGLEY ST NAVAL BRANCH HEALTH CLINIC WHITING FIELD
MILTON FL
32570-6105
US

V. Phone/Fax

Practice location:
  • Phone: 850-623-7508
  • Fax:
Mailing address:
  • Phone: 850-623-7508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: