Healthcare Provider Details

I. General information

NPI: 1366653081
Provider Name (Legal Business Name): STEPHEN F. SCHOLLE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 ESTERO BLVD STE 1
FORT MYERS BEACH FL
33931-2846
US

IV. Provider business mailing address

PO BOX 6970
FORT MYERS BEACH FL
33932-6970
US

V. Phone/Fax

Practice location:
  • Phone: 239-765-0007
  • Fax: 239-765-0247
Mailing address:
  • Phone: 239-765-0007
  • Fax: 239-765-0247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberME0033695
License Number StateFL

VIII. Authorized Official

Name: DR. STEPHEN F SCHOLLE
Title or Position: PRESIDENT
Credential: MD
Phone: 239-765-0007