Provider Demographics
NPI:1558548131
Name:FRANK T DIENST MD PA
Entity Type:Organization
Organization Name:FRANK T DIENST MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:T
Authorized Official - Last Name:DIENST
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:321-268-1995
Mailing Address - Street 1:123 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3377
Mailing Address - Country:US
Mailing Address - Phone:321-268-1995
Mailing Address - Fax:321-264-0727
Practice Address - Street 1:123 S PARK AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3377
Practice Address - Country:US
Practice Address - Phone:321-268-1995
Practice Address - Fax:321-264-0727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-26
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02904Medicaid
FL02904Medicaid