Healthcare Provider Details

I. General information

NPI: 1801200118
Provider Name (Legal Business Name): DPN USA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SPRING VILLAS PT STE 3000
WINTER SPRINGS FL
32708-6621
US

IV. Provider business mailing address

1890 STATE ROAD 436 SUITE 319
WINTER PARK FL
32792-2228
US

V. Phone/Fax

Practice location:
  • Phone: 480-862-1677
  • Fax: 480-718-7643
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALEXIS MEGEATH
Title or Position: VICE PRESIDENT, STRATEGIC OPS
Credential:
Phone: 480-356-0885