Provider Demographics
NPI:1962571240
Name:ALINDOGAN, JESULIN BARANDA (MD)
Entity type:Individual
Prefix:
First Name:JESULIN
Middle Name:BARANDA
Last Name:ALINDOGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1328
Mailing Address - Street 2:621 N TAMIAMI TRAIL
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275
Mailing Address - Country:US
Mailing Address - Phone:941-485-5654
Mailing Address - Fax:941-488-3469
Practice Address - Street 1:621 N TAMIAMI TRAIL
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275
Practice Address - Country:US
Practice Address - Phone:941-485-5645
Practice Address - Fax:941-488-3469
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32566208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL58356OtherBC BS
FL01934OtherUNIVERSAL
58356Medicare ID - Type Unspecified
FL01934OtherUNIVERSAL