Healthcare Provider Details

I. General information

NPI: 1396001350
Provider Name (Legal Business Name): JOHAN EMANUEL ESCRIBANO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHAN EMANUEL ESCRIBANO-FONTANET M.D

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 SUMMERLIN LAKES DR
FORT MYERS FL
33907-1849
US

IV. Provider business mailing address

8010 SUMMERLIN LAKES DR
FORT MYERS FL
33907-1849
US

V. Phone/Fax

Practice location:
  • Phone: 239-939-1767
  • Fax: 399-395-8952
Mailing address:
  • Phone: 239-939-1767
  • Fax: 239-939-5895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME139206
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME139206
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: