Provider Demographics
NPI:1417948142
Name:HOSEY, DAMANI A (MD)
Entity Type:Individual
Prefix:
First Name:DAMANI
Middle Name:A
Last Name:HOSEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-409-6800
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:730 MALABAR RD STE B
Practice Address - Street 2:
Practice Address - City:MALABAR
Practice Address - State:FL
Practice Address - Zip Code:32950-3140
Practice Address - Country:US
Practice Address - Phone:321-409-6800
Practice Address - Fax:321-409-6810
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88938207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37964XOtherMEDICARE
FLP01164151OtherRRMR
FLP00266636OtherRR MEDICARE
FL269522700Medicaid