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General NPI Number Information
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NPI Number | 1841463601
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Entity Type | Organization
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Legal Business Name | ROBERT B DEHGAN MD PA
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Dates
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Enumeration Date | 04/11/2008
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Last Update Date | 09/02/2009
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Provider Practice Location Address
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Address Line | 6500 CRILL AVE
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City | PALATKA
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State | FL
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Zip | 32177-6807
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Country | US
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Telephone | 386-325-0570
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Fax |
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Provider Business Mailing Address
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Address Line | 460 OSCEOLA AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32250-4078
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Country | US
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Telephone | 904-247-1919
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Fax | 904-246-0301
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Authorized Official
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Title or Position | CEO/ OWNER
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Name | ROBERT B DEHGAN
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Credential | MD
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Telephone | 904-794-9180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | ME16903
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License Number State | FL
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