MEDICARE: DR. JEAN RODRIGUE DOSSOUS MD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	9100887	FL

General Provider Information

NPI Number	:	1083931901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN RODRIGUE DOSSOUS MD.

Provider Business Mailing Address
First Line	:	3600 WILDERNESS DR W
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-6561
Country	:	US
Telephone Number	:	772-466-4573
Fax Number	:	772-465-7276

Provider Business Practice Location Address
First Line	:	2212 OKEECHOBEE RD
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-6551
Country	:	US
Telephone Number	:	772-465-8433
Fax Number	:	772-465-7276

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2010
Last Update Date	:	05/02/2010

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