Provider Demographics
NPI:1497748404
Name:BADGETT, DWAYNE K (MD)
Entity Type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:K
Last Name:BADGETT
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 11407
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4005
Mailing Address - Country:US
Mailing Address - Phone:321-255-8080
Mailing Address - Fax:321-242-2313
Practice Address - Street 1:8055 SPYGLASS HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8564
Practice Address - Country:US
Practice Address - Phone:321-255-8080
Practice Address - Fax:321-242-2313
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME915092086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL281097200Medicaid
FLME91509OtherFLORIDA MEDICAL LICENSE
FLME91509OtherFLORIDA MEDICAL LICENSE
FLME91509OtherFLORIDA MEDICAL LICENSE
FLU4079XMedicare PIN