Provider Demographics
NPI:1790784270
Name:DAUBERT, JACK STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:STEVEN
Last Name:DAUBERT
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 1:1050 SE MONTERRY RD
Mailing Address - Street 2:STE #104
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4512
Mailing Address - Country:US
Mailing Address - Phone:772-283-2020
Mailing Address - Fax:772-220-9582
Practice Address - Street 1:1050 SE MONTERRY RD
Practice Address - Street 2:STE #104
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4512
Practice Address - Country:US
Practice Address - Phone:772-283-2020
Practice Address - Fax:772-220-9582
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055247207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08501OtherBCBS OF FLORIDA
FL062348200Medicaid
08501VOtherMEDICARE RETIRED RAILROAD
08501UOtherMEDICARE RETIRED RAILROAD
08501UOtherMEDICARE RETIRED RAILROAD
FL062348200Medicaid
08501VOtherMEDICARE RETIRED RAILROAD