Individual
JACK DEROVANESIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6400 DAVIS BLVD STE 103, NAPLES, FL 34104-5321
(239) 775-2300
Mailing address
PO BOX 160448, MIAMI, FL 33116-0448
(239) 262-4519
(239) 262-5672
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME26879
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
067815500
—
FL
01
—
78470
BC BS FL
FL
Enumeration date
05/22/2006
Last updated
05/12/2008
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