Provider Demographics
NPI:1902069602
Name:DESSENT, JOSEPH E IV (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:E
Last Name:DESSENT
Suffix:IV
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-8220
Mailing Address - Fax:239-343-8221
Practice Address - Street 1:1569 MATTHEW DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1734
Practice Address - Country:US
Practice Address - Phone:239-343-8220
Practice Address - Fax:239-343-8221
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115242100Medicaid