Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME035779 | FL |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | ME035779 | FL |
NPI | 1508847229 |
---|---|
Provider Name | Donald Harry Dehaven |
First Address | Melbourne, FL 32940-8559 |
Second Address | Melbourne, FL 32940-8559 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 17/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01257726 | AMERIGROUP (01) | FL |
02042 | BLUE CROSS BLUE SHIELD (01) | FL |
1068059 | CAREPLUS MEDICARE (01) | FL |
19335 | FIRST HEALTHY (01) | |
225693 | WELLCARE (01) | FL |
5255803008 | CIGNA (01) | FL |
D50304 | (02) | |
P00018595 | RAILROAD MEDICARE (01) | FL |