Healthcare Provider Details

I. General information

NPI: 1417594623
Provider Name (Legal Business Name): WYOMING COUNTY FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5596 GAINESVILLE ROAD
CASTILE NY
14427
US

IV. Provider business mailing address

400 N MAIN ST
WARSAW NY
14569-1025
US

V. Phone/Fax

Practice location:
  • Phone: 585-793-9230
  • Fax:
Mailing address:
  • Phone: 585-786-8940
  • Fax: 585-492-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DALE DEAHN
Title or Position: OWNER
Credential: MD
Phone: 585-492-5088