Provider Demographics
NPI:1316958846
Name:DUSS, DAWN NOELLE (MD)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:NOELLE
Last Name:DUSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DAWN
Other - Middle Name:NOELLE
Other - Last Name:DUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:240 PONTE VEDRA PARK DRIVE
Mailing Address - Street 2:SUITE 202 PECNF
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082
Mailing Address - Country:US
Mailing Address - Phone:904-425-5075
Mailing Address - Fax:904-425-9414
Practice Address - Street 1:240 PONTE VEDRA PARK DRIVE
Practice Address - Street 2:SUITE 202 PECNF
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082
Practice Address - Country:US
Practice Address - Phone:904-425-5075
Practice Address - Fax:904-425-9414
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96217207W00000X, 208000000X, 207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275733800Medicaid
GA280916776EMedicaid
FL275733800Medicaid
GA280916776EMedicaid
AA259ZMedicare PIN