Provider Demographics
NPI:1790785426
Name:SABOL, DUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DUSAN
Middle Name:
Last Name:SABOL
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:PO BOX 561600
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32956-1600
Mailing Address - Country:US
Mailing Address - Phone:321-434-4600
Mailing Address - Fax:321-259-0625
Practice Address - Street 1:699 W COCOA BEACH CSWY
Practice Address - Street 2:SUITE 506
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931
Practice Address - Country:US
Practice Address - Phone:321-868-7222
Practice Address - Fax:321-868-7221
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0061396207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370497101Medicaid
FL15163WMedicare PIN