Healthcare Provider Details

I. General information

NPI: 1275716599
Provider Name (Legal Business Name): L DAWSON GLADDING PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1491 BEECHWOOD TRL
FORT MYERS FL
33919-3430
US

IV. Provider business mailing address

1491 BEECHWOOD TRL
FORT MYERS FL
33919-3430
US

V. Phone/Fax

Practice location:
  • Phone: 239-482-6254
  • Fax: 239-432-0548
Mailing address:
  • Phone: 239-482-6254
  • Fax: 239-432-0548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS3902
License Number StateFL

VIII. Authorized Official

Name: DR. LLOYD DAWSON GLADDING
Title or Position: PRES
Credential: D.O.
Phone: 239-425-6464