Provider Demographics
NPI:1760439525
Name:DASCHER, PHILLIP M (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:M
Last Name:DASCHER
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 1:1290 WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5229
Mailing Address - Country:US
Mailing Address - Phone:352-742-0054
Mailing Address - Fax:352-742-2103
Practice Address - Street 1:1290 WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5229
Practice Address - Country:US
Practice Address - Phone:352-742-0054
Practice Address - Fax:352-742-2103
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32089208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00311613OtherRAILROAD MEDICARE
FL265700700Medicaid
FL59256OtherBCBS
FL59256OtherBCBS
P00311613OtherRAILROAD MEDICARE