Healthcare Provider Details

I. General information

NPI: 1891943726
Provider Name (Legal Business Name): CYPRESS MEDICAL ASSOCIATES OF SWFL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9371 CYPRESS LAKE DR SUITE 12
FORT MYERS FL
33919-4939
US

IV. Provider business mailing address

9371 CYPRESS LAKE DR SUITE 12
FORT MYERS FL
33919-4939
US

V. Phone/Fax

Practice location:
  • Phone: 239-481-5252
  • Fax:
Mailing address:
  • Phone: 239-481-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME57429
License Number StateFL

VIII. Authorized Official

Name: ROBERT DIFRONZO
Title or Position: PVST
Credential: M.D.
Phone: 239-481-5252