Healthcare Provider Details

I. General information

NPI: 1578767174
Provider Name (Legal Business Name): JAMES ALTON BYNUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7331 COLLEGE PKWY SUITE 300
FORT MYERS FL
33907-5524
US

IV. Provider business mailing address

7331 COLLEGE PKWY SUITE 300
FORT MYERS FL
33907-5524
US

V. Phone/Fax

Practice location:
  • Phone: 239-337-2003
  • Fax: 239-337-3168
Mailing address:
  • Phone: 239-337-2003
  • Fax: 239-337-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME104582
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME104582
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: