Provider Demographics
NPI:1457353799
Name:DUSSEAULT, LOUIS GEORGE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:GEORGE
Last Name:DUSSEAULT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7717 COLLIER BLVD UNIT 202
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34114-2769
Mailing Address - Country:US
Mailing Address - Phone:239-624-8300
Mailing Address - Fax:239-624-8241
Practice Address - Street 1:7717 COLLIER BLVD UNIT 202
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-2769
Practice Address - Country:US
Practice Address - Phone:239-624-8300
Practice Address - Fax:239-624-8241
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA56357207R00000X
FLME139426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102793800Medicaid
FLWATVXOtherBCBS
MAD87944Medicare UPIN