Healthcare Provider Details

I. General information

NPI: 1962825794
Provider Name (Legal Business Name): PHYSICIANS PRIMARY CARE OF SOUTHWEST FLORIDA, PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 CAPE CORAL PKWY W STE 2
CAPE CORAL FL
33914-6985
US

IV. Provider business mailing address

12730 NEW BRITTANY BLVD STE 602
FORT MYERS FL
33907-4690
US

V. Phone/Fax

Practice location:
  • Phone: 239-945-5940
  • Fax: 239-945-5941
Mailing address:
  • Phone: 239-275-5522
  • Fax: 239-275-4464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. JON BURDZY
Title or Position: MANAGING PHYSICIAN
Credential: DO
Phone: 239-275-5522