Healthcare Provider Details

I. General information

NPI: 1275530099
Provider Name (Legal Business Name): JAMES J. O'MAILIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date: 03/20/2006
Reactivation Date: 01/17/2007

III. Provider practice location address

1553 MATTHEW DR
FORT MYERS FL
33907-1734
US

IV. Provider business mailing address

15000 SHELL POINT BLVD STE 100
FORT MYERS FL
33908-1657
US

V. Phone/Fax

Practice location:
  • Phone: 239-275-3695
  • Fax: 239-275-5402
Mailing address:
  • Phone: 239-542-1464
  • Fax: 239-454-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME53585
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME53585
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: