Healthcare Provider Details

I. General information

NPI: 1518911668
Provider Name (Legal Business Name): FLORIDA RADIOLOGY CONSULTANTS P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2776 CLEVELAND AVE DEPT. OF RADIOLOGY
FORT MYERS FL
33901-5864
US

IV. Provider business mailing address

8791 CONFERENCE DR SUITE 1
FORT MYERS FL
33919-5822
US

V. Phone/Fax

Practice location:
  • Phone: 239-331-5566
  • Fax: 239-377-4994
Mailing address:
  • Phone: 239-331-5566
  • Fax: 239-437-7499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberNA
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberNA
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberNA
License Number StateFL

VIII. Authorized Official

Name: JAMAL KSAR
Title or Position: PRESIDENT
Credential: MD
Phone: 239-331-5566