MEDICARE: CARL F DENNISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0000X	Adolescent Medicine (Family Medicine) Physician	ME62956	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114032109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL F DENNISON

Provider Business Mailing Address
First Line	:	3035 E COMMERCIAL BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4347
Country	:	US
Telephone Number	:	954-776-4981
Fax Number	:	954-776-0146

Provider Business Practice Location Address
First Line	:	3035 E COMMERCIAL BLVD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-4347
Country	:	US
Telephone Number	:	954-776-4981
Fax Number	:	954-776-0146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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Directions to “ CARL F DENNISON ” Practice Location

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