Healthcare Provider Details

I. General information

NPI: 1992722607
Provider Name (Legal Business Name): BEATRICE L FAGEL-FACTORA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18070 S TAMIAMI TRL SUITE 8
FORT MYERS FL
33908-4602
US

IV. Provider business mailing address

18070 S TAMIAMI TRL SUITE 8
FORT MYERS FL
33908-4602
US

V. Phone/Fax

Practice location:
  • Phone: 239-267-3031
  • Fax: 239-267-2434
Mailing address:
  • Phone: 239-267-3031
  • Fax: 239-267-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME62961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: