Organization
EVAN EARL DUSSIA II MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EVAN EARL DUSSIA II MD (MANAGER)
(850) 583-2926
Entity
Organization
Contact information
Practice address
1030 E LAFAYETTE ST STE 4, TALLAHASSEE, FL 32301-4547
(850) 583-2926
(850) 792-6043
Mailing address
1020 E LAFAYETTE ST, SUITE:101, TALLAHASSEE, FL 32301-4569
(850) 583-2696
(850) 792-6043
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
065885500
—
FL
Enumeration date
01/14/2015
Last updated
01/14/2015
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