Provider Demographics
NPI:1922189224
Name:DASH, JEFFREY A (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:DASH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2625
Practice Address - Street 1:333 MIAMI AVE W
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2361
Practice Address - Country:US
Practice Address - Phone:941-584-4860
Practice Address - Fax:941-584-4859
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80480OtherBCBS
FL80480YOtherMEDICARE PIN
FL80480ZMedicare PIN