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General NPI Number Information
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NPI Number | 1003050352
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Entity Type | Organization
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Legal Business Name | DONALD H. DEHAVEN MD
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Dates
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Enumeration Date | 04/29/2009
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Last Update Date | 04/29/2009
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Provider Practice Location Address
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Address Line | 8057 SPYGLASS HILL RD UNIT 104
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City | MELBOURNE
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State | FL
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Zip | 32940-8565
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Country | US
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Telephone | 321-622-8943
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Fax | 321-622-8945
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Provider Business Mailing Address
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Address Line | 8057 SPYGLASS HILL RD UNIT 104
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City | MELBOURNE
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State | FL
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Zip | 32940-8565
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Country | US
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Telephone | 321-622-8943
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Fax | 321-622-8945
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DONALD H DEHAVEN
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Credential | MD
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Telephone | 321-622-8943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME035779
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License Number State | FL
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