Healthcare Provider Details

I. General information

NPI: 1609962737
Provider Name (Legal Business Name): EDWARD FLETCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 12/07/2025
Certification Date: 05/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 SANDCHASE CIR
INLET BEACH FL
32461-9507
US

IV. Provider business mailing address

73 SANDCHASE CIR
INLET BEACH FL
32461-9507
US

V. Phone/Fax

Practice location:
  • Phone: 850-482-1442
  • Fax:
Mailing address:
  • Phone: 850-482-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 76063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: