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General NPI Number Information
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NPI Number | 1215924154
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Entity Type | Individual
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Provider Name | JONATHAN S DAITCH MD
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Gender | Male
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 8255 COLLEGE PKWY STE 100
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City | FORT MYERS
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State | FL
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Zip | 33919-5119
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Country | US
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Telephone | 239-437-8000
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Fax | 239-437-9991
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Provider Business Mailing Address
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Address Line | PO BOX 07400
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City | FORT MYERS
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State | FL
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Zip | 33919-0391
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Country | US
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Telephone | 239-437-8000
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Fax | 239-437-9991
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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 | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | ME60798
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License Number State | FL
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