Healthcare Provider Details

I. General information

NPI: 1821420845
Provider Name (Legal Business Name): GENTLE CARE OB GYN AND INFERTILITY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 CENTRAL AVE STE 7
FORT MYERS FL
33901-8257
US

IV. Provider business mailing address

3615 CENTRAL AVE STE 7
FORT MYERS FL
33901-8257
US

V. Phone/Fax

Practice location:
  • Phone: 239-939-3100
  • Fax: 239-939-3104
Mailing address:
  • Phone: 239-939-3100
  • Fax: 239-939-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME100568
License Number StateFL

VIII. Authorized Official

Name: DR. NORRIS MICHAEL ALLEN
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 239-939-3100