Provider Demographics
NPI:1285785139
Name:RACKLEFF, DEAN L (MD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:L
Last Name:RACKLEFF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3467 PINE RIDGE RD
Mailing Address - Street 2:STE 103
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3832
Mailing Address - Country:US
Mailing Address - Phone:239-455-9946
Mailing Address - Fax:239-455-9947
Practice Address - Street 1:3467 PINE RIDGE RD
Practice Address - Street 2:103
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-3832
Practice Address - Country:US
Practice Address - Phone:239-455-9946
Practice Address - Fax:239-455-9947
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2012-10-04
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Provider Licenses
StateLicense IDTaxonomies
FLME0069187207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28141OtherBCBS
FL460002284OtherMEDICARE RAILROAD
FL378687100Medicaid
FL28141OtherBCBS
FLF76425Medicare UPIN