MEDICARE: DR. JOHN EDWIN DENNIE MD

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	207L00000X	Anesthesiology Physician	ME52193	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
2	04928	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1326022500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN EDWIN DENNIE MD

Provider Business Mailing Address
First Line	:	PO BOX 3130
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34478-3130
Country	:	US
Telephone Number	:	352-867-8311
Fax Number	:	352-867-1053

Provider Business Practice Location Address
First Line	:	1000 WATERMAN WAY
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-5266
Country	:	US
Telephone Number	:	352-253-3333
Fax Number	:

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	01/13/2009

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