Healthcare Provider Details

I. General information

NPI: 1790733749
Provider Name (Legal Business Name): JUAN ANTONIO DUMOIS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 6TH ST S BOX 7810
ST PETERSBURG FL
33701-4827
US

IV. Provider business mailing address

679 RIVIERA BAY DR NE
ST PETERSBURG FL
33702-2709
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-4160
  • Fax: 727-767-8270
Mailing address:
  • Phone: 727-767-4160
  • Fax: 727-767-8270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberME0054768
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: