Healthcare Provider Details

I. General information

NPI: 1912081464
Provider Name (Legal Business Name): DAWN DAVIDSON-JOCKOVICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13695 US HIGHWAY 1
SEBASTIAN FL
32958-3230
US

IV. Provider business mailing address

460 RIGGS AVE
MELBOURNE BEACH FL
32951-3221
US

V. Phone/Fax

Practice location:
  • Phone: 772-581-2044
  • Fax:
Mailing address:
  • Phone: 321-956-0495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberME66378
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License NumberME66378
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME66378
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: