Provider Demographics
NPI:1518916642
Name:HILDAHL, DEAN BOYD (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:BOYD
Last Name:HILDAHL
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 1:6610 WILLOW PARK DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0921
Mailing Address - Country:US
Mailing Address - Phone:239-593-5510
Mailing Address - Fax:239-593-5414
Practice Address - Street 1:1865 VETERANS PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0447
Practice Address - Country:US
Practice Address - Phone:239-593-5510
Practice Address - Fax:239-593-5414
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72896207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253001500Medicaid
FL41706OtherBLUE CROSS BLUE SHIELD
FL253001500Medicaid
D25955Medicare UPIN