Provider Demographics
NPI:1477934198
Name:FLEETWOOD, DENNIS RAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:RAY
Last Name:FLEETWOOD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 ODESSA CIR
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-3830
Mailing Address - Country:US
Mailing Address - Phone:901-412-3664
Mailing Address - Fax:
Practice Address - Street 1:1989 ODESSA CIR
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-3830
Practice Address - Country:US
Practice Address - Phone:901-412-3664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM157213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist