Provider Demographics
NPI:1467721084
Name:DOLGAN, JEFF A (RCEP)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:A
Last Name:DOLGAN
Suffix:
Gender:M
Credentials:RCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 PALOMINO DRIVE
Mailing Address - Street 2:UNIT 412
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33024-0000
Mailing Address - Country:US
Mailing Address - Phone:954-392-9825
Mailing Address - Fax:
Practice Address - Street 1:3315 PALOMINO DRIVE
Practice Address - Street 2:UNIT 412
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33024-0000
Practice Address - Country:US
Practice Address - Phone:954-392-9825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1002242224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist