MEDICARE: FMB MEDICAL LLC

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	173000000X	Legal Medicine

General Provider Information

NPI Number	:	1568710853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FMB MEDICAL LLC

Provider Business Mailing Address
First Line	:	7205 ESTERO BLVD STE 733
Second Line	:
City	:	FORT MYERS BEACH
State	:	FL
Zip	:	33931-4779
Country	:	US
Telephone Number	:	239-463-5741
Fax Number	:	239-463-5578

Provider Business Practice Location Address
First Line	:	7205 ESTERO BLVD STE 733
Second Line	:
City	:	FORT MYERS BEACH
State	:	FL
Zip	:	33931-4779
Country	:	US
Telephone Number	:	239-463-5741
Fax Number	:	239-463-5578

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NITA DRUMM
Credential	:
Telephone Number	:	239-463-5741

Provider Enumeration Date	:	08/17/2012
Last Update Date	:	05/02/2017

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