Provider Demographics
NPI:1629031091
Name:NINER, DENNIS ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:ANTHONY
Last Name:NINER
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 1:620 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34601-2518
Mailing Address - Country:US
Mailing Address - Phone:352-799-7073
Mailing Address - Fax:352-799-7673
Practice Address - Street 1:620 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-2518
Practice Address - Country:US
Practice Address - Phone:352-799-7073
Practice Address - Fax:352-799-7673
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29080207QH0002X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259403000Medicaid
FL259403000Medicaid
FL93418AMedicare ID - Type Unspecified