MEDICARE: JEFF A DOLGAN RCEP

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	224Y00000X	Clinical Exercise Physiologist	1002242	FL

General Provider Information

NPI Number	:	1467721084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF A DOLGAN RCEP

Provider Business Mailing Address
First Line	:	3315 PALOMINO DRIVE
Second Line	:	UNIT 412
City	:	DAVIE
State	:	FL
Zip	:	33024-0000
Country	:	US
Telephone Number	:	954-392-9825
Fax Number	:

Provider Business Practice Location Address
First Line	:	3315 PALOMINO DRIVE
Second Line	:	UNIT 412
City	:	DAVIE
State	:	FL
Zip	:	33024-0000
Country	:	US
Telephone Number	:	954-392-9825
Fax Number	:

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

Provider Enumeration Date	:	12/28/2011
Last Update Date	:	12/28/2011

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Directions to “ JEFF A DOLGAN RCEP” Practice Location

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