Provider Demographics
NPI:1326099003
Name:DERNBACH, PAUL DAVID (ME)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:DERNBACH
Suffix:
Gender:M
Credentials:ME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 GOODLETTE RD N
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5616
Mailing Address - Country:US
Mailing Address - Phone:239-262-1721
Mailing Address - Fax:236-262-1045
Practice Address - Street 1:730 GOODLETTE RD N
Practice Address - Street 2:SUITE 100
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5616
Practice Address - Country:US
Practice Address - Phone:239-262-1721
Practice Address - Fax:236-262-1045
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061520207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260277600Medicaid
FL14803OtherBCBS
FLAD3147243OtherDEA
FLAD3147243OtherDEA
FL14803VMedicare ID - Type Unspecified