Healthcare Provider Details

I. General information

NPI: 1407856149
Provider Name (Legal Business Name): JAN A DUVOISIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MAIN ST STE 205
DUNEDIN FL
34698-5848
US

IV. Provider business mailing address

PO BOX 1074
DUNEDIN FL
34697-1074
US

V. Phone/Fax

Practice location:
  • Phone: 727-734-6516
  • Fax: 727-734-4516
Mailing address:
  • Phone: 727-734-6516
  • Fax: 727-734-4516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME44443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: