Provider Demographics
NPI:1760589048
Name:DEAN HILDAHL, M.D. P.A.
Entity Type:Organization
Organization Name:DEAN HILDAHL, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:HILDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-593-5510
Mailing Address - Street 1:5500 BRYSON DR STE 301
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0921
Mailing Address - Country:US
Mailing Address - Phone:239-593-5510
Mailing Address - Fax:239-593-5414
Practice Address - Street 1:5500 BRYSON DR STE 301
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0921
Practice Address - Country:US
Practice Address - Phone:239-593-5510
Practice Address - Fax:239-593-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72896207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41706OtherBLUE CROSS/BLUE SHIELD
FLQ0118Medicare ID - Type UnspecifiedGROUP NUMBER
D25955Medicare UPIN