Healthcare Provider Details

I. General information

NPI: 1437248648
Provider Name (Legal Business Name): BRIAN K DOERR DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14391 METROPOLIS AVENUE SUITE 103
FORT MYERS FL
33912
US

IV. Provider business mailing address

14391 METROPOLIS AVE SUITE 103
FORT MYERS FL
33912
US

V. Phone/Fax

Practice location:
  • Phone: 239-931-3668
  • Fax: 239-333-3669
Mailing address:
  • Phone: 239-931-3668
  • Fax: 239-333-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3044
License Number StateFL

VIII. Authorized Official

Name: APRIL E DOERR
Title or Position: PRESIDENT
Credential:
Phone: 239-931-3668