Provider Demographics
NPI:1578187266
Name:BAE, DENNIS (DO)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:BAE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-8208
Mailing Address - Country:US
Mailing Address - Phone:407-646-5500
Mailing Address - Fax:
Practice Address - Street 1:7975 LAKE UNDERHILL RD STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8204
Practice Address - Country:US
Practice Address - Phone:407-303-6830
Practice Address - Fax:407-303-6839
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101026964207Q00000X
FLOS20742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine