Healthcare Provider Details

I. General information

NPI: 1043931439
Provider Name (Legal Business Name): PTG MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 NE 8TH STREET UNIT 109
CAPE CORAL FL
33909
US

IV. Provider business mailing address

1260 NE 8TH ST STE 109
CAPE CORAL FL
33909-3169
US

V. Phone/Fax

Practice location:
  • Phone: 239-579-7988
  • Fax: 239-579-7898
Mailing address:
  • Phone: 239-573-7988
  • Fax: 239-573-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK KING
Title or Position: OWNER
Credential: DC
Phone: 239-573-7988