Provider Demographics
NPI:1487645537
Name:DENNIS, JON E (MD, MPH, FAAP)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:E
Last Name:DENNIS
Suffix:
Gender:M
Credentials:MD, MPH, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIR
Mailing Address - Street 2:SUITE #1300
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3630
Mailing Address - Fax:320-654-3657
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:SUITE #1300
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3630
Practice Address - Fax:320-654-3657
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN24057208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SHP50A90DEOtherBLUE CROSS BLUE SHIELD
556146OtherARAZ GROUP AMERICAS PPO
254009OtherPREFERRED ONE
110408OtherU CARE
1123622OtherFIRST HEALTH PLAN
51A32DEOtherBLUE CROSS BLUE SHIELD
1202199OtherMEDICA HEALTH PLANS
HP25415OtherHEALTH PARTNERS
HP25415OtherHEALTH PARTNERS