| Entity Name: | DEAN EDMUND ALTENHOFEN, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 31 Jan 1997 (28 years ago) |
| Document Number: | P97000009764 |
| FEI/EIN Number | 593428041 |
| Address: | 4455 Devereux Place, Pensacola, FL, 32504, US |
| Mail Address: | 4455 Devereux Place, Pensacola, FL, 32504, US |
| ZIP code: | 32504 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003193756 | 2011-11-09 | 2011-11-28 | 6110 N DAVIS HWY, PENSACOLA, FL, 325046950, US | 6110 N DAVIS HWY, PENSACOLA, FL, 325046950, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 850-475-0902 |
| Fax | 8504750908 |
Authorized person
| Name | DR. DEAN E ALTENHOFEN |
| Role | PHYSICIAN |
| Phone | 8504750902 |
Taxonomy
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| License Number | ME0046652 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 047401100 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD OF FLORIDA |
| Number | 02245 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD OF ALABAMA |
| Number | 59146654 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ALTENHOFEN DEAN E | Agent | 4455 Devereux Place, Pensacola, FL, 32504 |
| Name | Role | Address |
|---|---|---|
| Altenhofen Dean E | President | 4455 Devereux Place, Pensacola, FL, 32504 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000019090 | DEAN E. ALTENHOFEN, M.D., P.A. | ACTIVE | 2022-01-18 | 2027-12-31 | No data | 6110 N. DAVIS HIGHWAY, PENSACOLA, FL, 32504 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-02-15 | 4455 Devereux Place, Pensacola, FL 32504 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-15 | 4455 Devereux Place, Pensacola, FL 32504 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-15 | 4455 Devereux Place, Pensacola, FL 32504 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-11-17 | ALTENHOFEN, DEAN E. | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J17000549644 | LAPSED | 502017CA002994 | FIFTEENTH JUDICIAL CIRCUIT | 2017-10-02 | 2022-10-09 | $12,377.54 | MED DIRECT CAPITAL, LLC, 151 NW 1ST AVE, DELRAY, BEACH, FLORIDA 33444 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-20 |
| ANNUAL REPORT | 2023-02-15 |
| ANNUAL REPORT | 2022-02-15 |
| AMENDED ANNUAL REPORT | 2021-11-17 |
| ANNUAL REPORT | 2021-02-05 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-02-09 |
| ANNUAL REPORT | 2018-03-11 |
| ANNUAL REPORT | 2017-03-17 |
| ANNUAL REPORT | 2016-01-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
