Provider Demographics
NPI:1467434720
Name:DENNIS, DANIEL A III (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:DENNIS
Suffix:III
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 1:50B MIDTOWN PARK W
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-4148
Mailing Address - Country:US
Mailing Address - Phone:251-435-5114
Mailing Address - Fax:
Practice Address - Street 1:5 MOBILE INFIRMARY CIR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3513
Practice Address - Country:US
Practice Address - Phone:251-435-5114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10944208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-00127OtherBCBS
AL511-00126OtherBCBS
AL114482Medicaid
AL1467434720OtherTRICARE SOUTH
AL511-00125OtherBCBS
AL051023466OtherBLUE CROSS BLUE SHIELD
AL114447Medicaid
AL114448Medicaid
AL114481Medicaid
AL511-00128OtherBCBS
AL000023466Medicaid
ALP00767946Medicare PIN
C75664Medicare UPIN
AL511-00125OtherBCBS
AL114447Medicaid