Healthcare Provider Details

I. General information

NPI: 1326099003
Provider Name (Legal Business Name): PAUL DAVID DERNBACH ME
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 GOODLETTE RD N SUITE 100
NAPLES FL
34102-5616
US

IV. Provider business mailing address

730 GOODLETTE RD N SUITE 100B
NAPLES FL
34102-5616
US

V. Phone/Fax

Practice location:
  • Phone: 239-262-1721
  • Fax: 236-262-1045
Mailing address:
  • Phone: 239-262-1721
  • Fax: 236-262-1045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME0061520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: