Healthcare Provider Details

I. General information

NPI: 1740645357
Provider Name (Legal Business Name): JACK LOMANO MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2015
Last Update Date: 12/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15644 CALOOSA CREEK CIR
FORT MYERS FL
33908-6736
US

IV. Provider business mailing address

15644 CALOOSA CREEK CIR
FORT MYERS FL
33908-6736
US

V. Phone/Fax

Practice location:
  • Phone: 239-470-8809
  • Fax: 239-236-3900
Mailing address:
  • Phone: 239-470-8809
  • Fax: 239-236-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME33323
License Number StateFL

VIII. Authorized Official

Name: JACK M LOMANO
Title or Position: PHYSICIAN
Credential: MD
Phone: 239-470-8809