Provider Demographics
NPI:1083606198
Name:DEUPREE, DANA M (MD)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:M
Last Name:DEUPREE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 859
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34682-0859
Mailing Address - Country:US
Mailing Address - Phone:727-789-8770
Mailing Address - Fax:727-789-8784
Practice Address - Street 1:3280 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 120
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2029
Practice Address - Country:US
Practice Address - Phone:727-789-8770
Practice Address - Fax:727-789-8784
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2022-07-21
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-07
Provider Licenses
StateLicense IDTaxonomies
FLME58570207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056403600Medicaid
FL12241SMedicare ID - Type Unspecified
FL056403600Medicaid