Derovanesian, Jack

Derovanesian, Jack is an individual health care provider with primary practice located at 6400 Davis Blvd Ste 103 , Naples FL 34104-5321. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Derovanesian, Jack can be contacted via phone (239) 775-2300.

Contact Information

Primary practice address
6400 Davis Blvd Ste 103 Naples FL 34104-5321
Phone: (239) 775-2300
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X ME26879 Florida

Profile Details

NPI number 1073567186
LBN Legal business name Derovanesian, Jack
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 22nd, 2006
Last updated May 12th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073567186 NPPES
Florida Other 78470 BC BS FL
Florida MEDICAID 067815500 BC BS FL

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