Healthcare Provider Details

I. General information

NPI: 1912392812
Provider Name (Legal Business Name): ROBERT WILLIAM FUNG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16131 ROSERUSH CT
FORT MYERS FL
33908-3634
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-7300
  • Fax: 239-343-5325
Mailing address:
  • Phone: 239-343-7300
  • Fax: 239-343-5325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberOS019410
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberOS19651
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS19651
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number008130
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: