Healthcare Provider Details

I. General information

NPI: 1447952783
Provider Name (Legal Business Name): ALEXANDER AVERY ASH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19511 HIGHLAND OAKS DR STE 201
ESTERO FL
33928-9712
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-468-0254
  • Fax: 239-343-3958
Mailing address:
  • Phone: 239-468-0254
  • Fax: 239-343-3958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number89891
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS23212
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number89891
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: