Healthcare Provider Details

I. General information

NPI: 1376611962
Provider Name (Legal Business Name): CAPE CORAL EMERGENCY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/17/2021
Certification Date: 05/07/2021
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

PO BOX 9536
DAYTONA BEACH FL
32120-9536
US

V. Phone/Fax

Practice location:
  • Phone: 239-772-6513
  • Fax:
Mailing address:
  • Phone: 386-274-7800
  • Fax: 833-547-6530

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: DR. TIMOTHY DOUGHERTY
Title or Position: MEDICAL DIRECTOR
Credential: M. D.
Phone: 239-424-3513