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General NPI Number Information
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NPI Number | 1083931901
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Entity Type | Individual
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Provider Name | JEAN RODRIGUE DOSSOUS MD.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2010
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Last Update Date | 05/02/2010
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Provider Practice Location Address
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Address Line | 2212 OKEECHOBEE RD
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City | FORT PIERCE
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State | FL
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Zip | 34950-6551
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Country | US
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Telephone | 772-465-8433
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Fax | 772-465-7276
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Provider Business Mailing Address
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Address Line | 3600 WILDERNESS DR W
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City | FORT PIERCE
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State | FL
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Zip | 34982-6561
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Country | US
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Telephone | 772-466-4573
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Fax | 772-465-7276
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9100887
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License Number State | FL
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