Provider Demographics
NPI:1629073200
Name:DOSORETZ, DANIEL E (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:DOSORETZ
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 1:3080 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6720
Mailing Address - Country:US
Mailing Address - Phone:941-883-2199
Mailing Address - Fax:941-979-5041
Practice Address - Street 1:3080 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952
Practice Address - Country:US
Practice Address - Phone:941-883-2199
Practice Address - Fax:941-979-5041
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00387012085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066995400Medicaid
FL24-05175OtherUTD. HLTHCR. PROVIDER #
FL214057OtherAVMED PROVIDER NUMBER
FL4129702OtherAETNA PROVIDER NUMBER
FLME38701AOtherMETCARE PROVIDER ID #
FL0850OtherAVMED PIN NUMBER
FL592485899OtherMETCARE VENDOR NUMBER
FL85476OtherOP. ENG. LOC. 825 PROV. #
FL3842755-016OtherCIGNA PROVIDER NUMBER
FL79697OtherBCBS PROVIDER NUMBER
FL1115384OtherWELLCARE (STAYWELL-MEDICAID AND WELLCARE-MEDICARE)
FL066995400Medicaid
FL066995400Medicaid
FL0850OtherAVMED PIN NUMBER
FL1115384OtherWELLCARE (STAYWELL-MEDICAID AND WELLCARE-MEDICARE)