Healthcare Provider Details

I. General information

NPI: 1922210160
Provider Name (Legal Business Name): DENISE DRAGO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23450 VIA COCONUT PT
ESTERO FL
34135-1877
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-468-0154
  • Fax: 239-343-4055
Mailing address:
  • Phone: 239-468-0154
  • Fax: 239-343-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME109300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: