Healthcare Provider Details

I. General information

NPI: 1952373367
Provider Name (Legal Business Name): DOUGLAS MICHAEL STEVENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 COMMERCE CENTER CT STE 101
FORT MYERS FL
33908-3817
US

IV. Provider business mailing address

9711 COMMERCE CENTER CT STE 101
FORT MYERS FL
33908-3817
US

V. Phone/Fax

Practice location:
  • Phone: 239-939-2621
  • Fax: 239-939-3875
Mailing address:
  • Phone: 239-939-2621
  • Fax: 239-939-3875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberME0068103
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: