Healthcare Provider Details

I. General information

NPI: 1316958846
Provider Name (Legal Business Name): DAWN NOELLE DUSS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAWN NOELLE DUSS MD

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 PONTE VEDRA PARK DRIVE SUITE 202 PECNF
PONTE VEDRA BEACH FL
32082
US

IV. Provider business mailing address

240 PONTE VEDRA PARK DRIVE SUITE 202 PECNF
PONTE VEDRA BEACH FL
32082
US

V. Phone/Fax

Practice location:
  • Phone: 904-425-5075
  • Fax: 904-425-9414
Mailing address:
  • Phone: 904-425-5075
  • Fax: 904-425-9414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME96217
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME96217
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License NumberME96217
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: