Individual
DR. JONATHAN S DAITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8255 COLLEGE PKWY, STE 100, FORT MYERS, FL 33919-5119
(239) 437-8000
(239) 437-9991
Mailing address
PO BOX 07400, FORT MYERS, FL 33919-0391
(239) 437-8000
(239) 437-9991
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
ME60798
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
056302100
—
FL
01
—
12953
BCBS
FL
01
—
4222838
AETNA
—
01
—
955549006
CIGNA
—
Enumeration date
10/05/2005
Last updated
06/06/2024
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