Provider Demographics
NPI:1083931901
Name:DOSSOUS, JEAN RODRIGUE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:RODRIGUE
Last Name:DOSSOUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:MARIE
Other - Last Name:DOSSOUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3600 WILDERNESS DR W
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-6561
Mailing Address - Country:US
Mailing Address - Phone:772-466-4573
Mailing Address - Fax:772-465-7276
Practice Address - Street 1:2212 OKEECHOBEE RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-6551
Practice Address - Country:US
Practice Address - Phone:772-465-8433
Practice Address - Fax:772-465-7276
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-02
Last Update Date:2010-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9100887363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical