Provider Demographics
NPI:1528014545
Name:THEOPHILOPOULOS, DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:
Last Name:THEOPHILOPOULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CONSTANTINE
Other - Middle Name:GERASIMOS
Other - Last Name:THEOPHILOPOULOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:150 N SPRING BLVD
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3247
Mailing Address - Country:US
Mailing Address - Phone:727-271-5650
Mailing Address - Fax:727-946-9062
Practice Address - Street 1:1700 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3555
Practice Address - Country:US
Practice Address - Phone:941-917-5525
Practice Address - Fax:941-917-1689
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00756632080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43817OtherBC/BS NUMBER
FL254599300Medicaid