Healthcare Provider Details

I. General information

NPI: 1265412001
Provider Name (Legal Business Name): DIGESTIVE HEALTH PHYSICIANS PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7152 COCA SABAL LN
FT MYERS FL
33908-4263
US

IV. Provider business mailing address

7152 COCA SABAL LN
FT MYERS FL
33908-4263
US

V. Phone/Fax

Practice location:
  • Phone: 239-939-9939
  • Fax: 239-931-5078
Mailing address:
  • Phone: 239-939-9939
  • Fax: 239-931-5078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. PATTI H REIGLE
Title or Position: ADMINISTRATOR
Credential:
Phone: 239-939-9939