MEDICARE: DR. LOUIS GEORGE DUSSEAULT JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	56357	MA
2	207R00000X	Internal Medicine Physician	ME139426	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	WATVX	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457353799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS GEORGE DUSSEAULT JR. M.D.

Provider Business Mailing Address
First Line	:	7717 COLLIER BLVD UNIT 202
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34114-2769
Country	:	US
Telephone Number	:	239-624-8300
Fax Number	:	239-624-8241

Provider Business Practice Location Address
First Line	:	7717 COLLIER BLVD UNIT 202
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34114-2769
Country	:	US
Telephone Number	:	239-624-8300
Fax Number	:	239-624-8241

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/13/2019

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Directions to “ DR. LOUIS GEORGE DUSSEAULT JR. M.D.” Practice Location

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