MEDICARE: DR. JACOB DAGANI M. D.

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	207V00000X	Obstetrics & Gynecology Physician	35.063339	OH
2	207V00000X	Obstetrics & Gynecology Physician	LL854	FL

General Provider Information

NPI Number	:	1740283290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB DAGANI M. D.

Provider Business Mailing Address
First Line	:	1438 PATRIOT DR
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-6818
Country	:	US
Telephone Number	:	419-231-3128
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 JUDGE FRAN JAMIESON WAY
Second Line	:
City	:	VIERA
State	:	FL
Zip	:	32940-5998
Country	:	US
Telephone Number	:	321-639-5813
Fax Number	:

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

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	11/06/2019

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