Healthcare Provider Details

I. General information

NPI: 1003192931
Provider Name (Legal Business Name): DEXTER DAVID BUELOW RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 AVIAN AVE
FORT MYERS FL
33916-7836
US

IV. Provider business mailing address

4341 AVIAN AVE
FORT MYERS FL
33916-7836
US

V. Phone/Fax

Practice location:
  • Phone: 239-220-7369
  • Fax:
Mailing address:
  • Phone: 239-220-7369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number74995
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT10416
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: