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Individual

DONALD HARRY DEHAVEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD.

Contact information

Practice address
8041 SPYGLASS HILL RD, UNIT 102, MELBOURNE, FL 32940-8559
(321) 622-8943
(321) 622-8945
Mailing address
8041 SPYGLASS HILL RD, UNIT 102, MELBOURNE, FL 32940-8559
(321) 622-8943
(321) 622-8945

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME035779
FL
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
ME035779
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01257726
AMERIGROUP
FL
01
02042
BLUE CROSS BLUE SHIELD
FL
01
1068059
CAREPLUS MEDICARE
FL
01
19335
FIRST HEALTHY
01
225693
WELLCARE
FL
01
5255803008
CIGNA
FL
01
P00018595
RAILROAD MEDICARE
FL
Enumeration date
11/09/2005
Last updated
01/17/2012
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