Healthcare Provider Details

I. General information

NPI: 1467568915
Provider Name (Legal Business Name): LLOYD DAWSON GLADDING DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3095 KENNESAW ST
FORT MYERS FL
33916-7526
US

IV. Provider business mailing address

3095 KENNESAW ST
FORT MYERS FL
33916-7526
US

V. Phone/Fax

Practice location:
  • Phone: 239-425-6464
  • Fax: 239-432-0548
Mailing address:
  • Phone: 239-425-6464
  • Fax: 239-432-0548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberOS3902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: