Healthcare Provider Details

I. General information

NPI: 1205993813
Provider Name (Legal Business Name): JAY JOSEPH DOUCET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13685 DOCTORS WAY STE 100
FORT MYERS FL
33912-4337
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-1612
  • Fax: 239-343-4229
Mailing address:
  • Phone: 239-343-1612
  • Fax: 239-343-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberA69243
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberA69243
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA69243
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME168532
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME168532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: