Healthcare Provider Details

I. General information

NPI: 1073215893
Provider Name (Legal Business Name): JOVAN DUKIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 MOCCASIN WALLOW RD STE 203
PALMETTO FL
34221-7506
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 941-981-0050
  • Fax:
Mailing address:
  • Phone: 727-532-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number179247
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: