MEDICARE: LLOYD DAWSON GLADDING DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	OS3902	FL

General Provider Information

NPI Number	:	1467568915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LLOYD DAWSON GLADDING DO

Provider Business Mailing Address
First Line	:	3095 KENNESAW ST
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-7526
Country	:	US
Telephone Number	:	239-425-6464
Fax Number	:	239-432-0548

Provider Business Practice Location Address
First Line	:	3095 KENNESAW ST
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33916-7526
Country	:	US
Telephone Number	:	239-425-6464
Fax Number	:	239-432-0548

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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