Provider Demographics
NPI:1619929924
Name:DAUPHIN, JEAN RAYMOND (DO)
Entity type:Individual
Prefix:
First Name:JEAN RAYMOND
Middle Name:
Last Name:DAUPHIN
Suffix:
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 1:8910 MIRAMAR PKWY
Mailing Address - Street 2:SUITE 117
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4100
Mailing Address - Country:US
Mailing Address - Phone:954-433-5526
Mailing Address - Fax:954-433-5589
Practice Address - Street 1:8910 MIRAMAR PKWY
Practice Address - Street 2:SUITE 117
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-4100
Practice Address - Country:US
Practice Address - Phone:954-433-5526
Practice Address - Fax:954-433-5589
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF79356Medicare UPIN
FL80891YMedicare ID - Type Unspecified