Healthcare Provider Details

I. General information

NPI: 1477928810
Provider Name (Legal Business Name): NMS WEIGHTLOSS CLINIC II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 CYPRESS WAY E SUITE 45
NAPLES FL
34110-9275
US

IV. Provider business mailing address

6150 DIAMOND CENTRE COURT BLDG #400
FORT MYERS FL
33912
US

V. Phone/Fax

Practice location:
  • Phone: 239-325-1633
  • Fax: 239-325-1630
Mailing address:
  • Phone: 239-333-0828
  • Fax: 239-561-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL07000111368
License Number StateFL

VIII. Authorized Official

Name: PETER BLOY
Title or Position: CFO
Credential:
Phone: 239-333-0828