Provider Demographics
NPI:1285630806
Name:COLLEGE, DENNIS L (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:COLLEGE
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 1:1305 S FORT HARRISON AVE
Mailing Address - Street 2:STE C
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3301
Mailing Address - Country:US
Mailing Address - Phone:727-441-3366
Mailing Address - Fax:727-442-8171
Practice Address - Street 1:1305 S FORT HARRISON AVE
Practice Address - Street 2:STE C
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3301
Practice Address - Country:US
Practice Address - Phone:727-441-3366
Practice Address - Fax:727-442-8171
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30562207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62379OtherBC/BS
FL4045574OtherAETNA
FL110010623OtherRAILROAD MEDICARE
FL068046000Medicaid
FL4045574OtherAETNA
FLK3497Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
FL62379OtherBC/BS