Provider Demographics
NPI:1265585798
Name:DRYFUSS, JOHN AUGUSTUS JR
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:AUGUSTUS
Last Name:DRYFUSS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7109 NW 11TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3170
Mailing Address - Country:US
Mailing Address - Phone:352-331-1773
Mailing Address - Fax:352-331-1773
Practice Address - Street 1:7109 NW 11TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3170
Practice Address - Country:US
Practice Address - Phone:352-331-1773
Practice Address - Fax:352-331-1773
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0015017207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology