Healthcare Provider Details

I. General information

NPI: 1477511350
Provider Name (Legal Business Name): DUANE F CUMBERBATCH D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 BOARDROOM CIR
FORT MYERS FL
33919-4888
US

IV. Provider business mailing address

8851 BOARDROOM CIR
FORT MYERS FL
33919-4888
US

V. Phone/Fax

Practice location:
  • Phone: 239-481-7000
  • Fax: 239-481-8150
Mailing address:
  • Phone: 239-481-7000
  • Fax: 239-481-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2004021616
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07001025A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3354
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: