Provider Demographics
NPI:1275519639
Name:MCCOMMON, DENNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:MCCOMMON
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 616788
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6788
Mailing Address - Country:US
Mailing Address - Phone:407-859-2882
Mailing Address - Fax:407-859-3278
Practice Address - Street 1:207 W GORE ST
Practice Address - Street 2:STE. 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:407-859-2882
Practice Address - Fax:407-859-3278
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46186207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266365100Medicaid
FL266365100Medicaid
FL47730WMedicare PIN