Healthcare Provider Details

I. General information

NPI: 1568892800
Provider Name (Legal Business Name): PREVENTATIVE MEDICINE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2013
Last Update Date: 11/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28901 TRAILS EDGE BLVD UNIT 103
BONITA SPRINGS FL
34134-7588
US

IV. Provider business mailing address

1007 TIVOLI DR
NAPLES FL
34104-0863
US

V. Phone/Fax

Practice location:
  • Phone: 239-877-2951
  • Fax: 239-349-2608
Mailing address:
  • Phone: 239-877-2951
  • Fax: 239-349-2608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberOS 10008
License Number StateFL

VIII. Authorized Official

Name: STEVEN FREDERICK WOODRING
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 239-877-2951