Provider Demographics
NPI:1104832641
Name:DENNIS, DAVID KEITH (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KEITH
Last Name:DENNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7351 W OAKLAND PARK BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-7107
Mailing Address - Country:US
Mailing Address - Phone:954-749-6955
Mailing Address - Fax:954-578-2783
Practice Address - Street 1:260 SW 84TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2715
Practice Address - Country:US
Practice Address - Phone:954-370-8585
Practice Address - Fax:954-370-1585
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0060803207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374287300Medicaid
FLF20940Medicare UPIN
FL374287300Medicaid