Provider Demographics
NPI:1841219839
Name:DEANA, DANIEL G (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:DEANA
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:PO BOX 15759
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32406-5759
Mailing Address - Country:US
Mailing Address - Phone:850-763-0260
Mailing Address - Fax:850-769-0892
Practice Address - Street 1:760 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4003
Practice Address - Country:US
Practice Address - Phone:850-763-0260
Practice Address - Fax:850-769-0892
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066462207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25410OtherBLUE CROSS BLUE SHIELD
FL375867200Medicaid
FL220013049OtherRAILROAD MEDICARE
FL25410OtherBLUE CROSS BLUE SHIELD
FL25410ZMedicare PIN