Provider Demographics
NPI:1023083177
Name:DALI, JOHN CHRISTOFER (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CHRISTOFER
Last Name:DALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1005 MAR WALT DR
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-863-8255
Mailing Address - Fax:850-862-7965
Practice Address - Street 1:999 MAR WALT DRIVE
Practice Address - Street 2:WHITE-WILSON EAST BUILDING
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6707
Practice Address - Country:US
Practice Address - Phone:850-863-8269
Practice Address - Fax:850-862-7965
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82923208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01075OtherBCBSFL
FL262332300Medicaid
FL262332300Medicaid
FL01075YMedicare PIN