Provider Demographics
NPI:1720303589
Name:DOSORETZ, ARIE P (MD)
Entity Type:Individual
Prefix:DR
First Name:ARIE
Middle Name:P
Last Name:DOSORETZ
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 1:15681 NEW HAMPSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4123
Mailing Address - Country:US
Mailing Address - Phone:239-437-1977
Mailing Address - Fax:239-437-1889
Practice Address - Street 1:15681 NEW HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4123
Practice Address - Country:US
Practice Address - Phone:239-437-1977
Practice Address - Fax:239-437-1889
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1245972085R0001X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLR138OtherMEDICARE PTAN
FL015248100Medicaid
FLP01503286OtherRAILROAD MEDICARE
FL1510TOtherBCBS
FL1510TOtherBCBS
FL1510TOtherBCBS
FL015248100Medicaid
FL4937762OtherAETNA
FLIF313YOtherMEDICARE (CHARLOTTE COUNTY)
FLIF313ZOtherMEDICARE (LEE COUNTY)
FLP1030602OtherFREEDOM