Provider Demographics
NPI:1578540027
Name:ALTENHOFEN, DEAN EDMUND (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:EDMUND
Last Name:ALTENHOFEN
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 1:6110 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6950
Mailing Address - Country:US
Mailing Address - Phone:850-475-0902
Mailing Address - Fax:850-475-0908
Practice Address - Street 1:6110 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6950
Practice Address - Country:US
Practice Address - Phone:850-475-0902
Practice Address - Fax:850-475-0908
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46652207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02245OtherBLUE CHOICE
FL047401100OtherHEALTHEASE
FL047401100OtherSTAYWELL
AL59146654OtherBLUE CROSS OF ALABAMA
FL02245OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FL02245OtherHEALTH OPTIONS
FL593428041OtherAETNA
FL047401100Medicaid
FL2/593428041/00001OtherUNITED HEALTHCARE
FL02245OtherWELLCARE
FL02245OtherNETWORK BLUE
FL051041OtherVISTA HEALTHPLANS
FL593428041OtherCIGNA
FL02245OtherHEALTHFIRST
FL047401100OtherMED3000
FL047401100OtherSTAYWELL
FL2/593428041/00001OtherUNITED HEALTHCARE