MEDICARE: DUCLOS DESSALINES MD

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	208000000X	Pediatrics Physician	ME102516	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

General Provider Information

NPI Number	:	1457503666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUCLOS DESSALINES MD

Provider Business Mailing Address
First Line	:	2601 10TH AVE N
Second Line	:	SUITE 100
City	:	PALM SPRINGS
State	:	FL
Zip	:	33461-3133
Country	:	US
Telephone Number	:	561-659-1270
Fax Number	:

Provider Business Practice Location Address
First Line	:	7408 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2502
Country	:	US
Telephone Number	:	561-370-1320
Fax Number	:	561-370-1390

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	01/12/2017

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