Healthcare Provider Details

I. General information

NPI: 1043213051
Provider Name (Legal Business Name): MARK S GOROVOY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12381 S CLEVELAND AVE STE 300
FORT MYERS FL
33907-3852
US

IV. Provider business mailing address

12381 S CLEVELAND AVE STE 300
FORT MYERS FL
33907-3852
US

V. Phone/Fax

Practice location:
  • Phone: 239-939-1444
  • Fax: 239-936-7710
Mailing address:
  • Phone: 239-939-1444
  • Fax: 239-936-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME39771
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: