Healthcare Provider Details

I. General information

NPI: 1356508410
Provider Name (Legal Business Name): LEA MOREEN BLACKWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13691 METRO PKWY STE 200
FORT MYERS FL
33912-4321
US

IV. Provider business mailing address

6321 DANIELS PKWY STE 200
FORT MYERS FL
33912-4710
US

V. Phone/Fax

Practice location:
  • Phone: 239-264-1236
  • Fax: 321-359-7055
Mailing address:
  • Phone: 941-626-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME102649
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: