Provider Demographics
NPI:1386629590
Name:BEHNER, DEAN A (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:A
Last Name:BEHNER
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 1107
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32704-1107
Mailing Address - Country:US
Mailing Address - Phone:407-886-1171
Mailing Address - Fax:407-886-8386
Practice Address - Street 1:125 S PARK AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703
Practice Address - Country:US
Practice Address - Phone:407-886-1171
Practice Address - Fax:407-886-8386
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037621300Medicaid
08685Medicare ID - Type Unspecified
FL037621300Medicaid