MEDICARE: DR. FIDEL ALEGRE VENTURA JR. M.D.

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	2084P0800X	Psychiatry Physician	ME94230	FL

General Provider Information

NPI Number	:	1578513594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FIDEL ALEGRE VENTURA JR. M.D.

Provider Business Mailing Address
First Line	:	100 4TH AVE S
Second Line	:	UNIT 328
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-4332
Country	:	US
Telephone Number	:	727-898-8142
Fax Number	:	727-898-8142

Provider Business Practice Location Address
First Line	:	12734 KENWOOD LN
Second Line	:	SUITE 84
City	:	FORT MYERS
State	:	FL
Zip	:	33907-5666
Country	:	US
Telephone Number	:	239-936-5250
Fax Number	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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