Healthcare Provider Details

I. General information

NPI: 1225093941
Provider Name (Legal Business Name): CAPE CORAL EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 DEL PRADO BLVD S
CAPE CORAL FL
33990-2668
US

IV. Provider business mailing address

6896 W SNOWVILLE RD
BRECKSVILLE OH
44141-3214
US

V. Phone/Fax

Practice location:
  • Phone: 239-772-6513
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY DOUGHERTY
Title or Position: MEDICAL DOCTOR
Credential:
Phone: 239-772-6513