Healthcare Provider Details

I. General information

NPI: 1427161348
Provider Name (Legal Business Name): JEFFERY LAOANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2776 CLEVELAND AVE
FORT MYERS FL
33901-5864
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-2606
  • Fax:
Mailing address:
  • Phone: 239-343-2606
  • Fax: 239-343-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME94885
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: