Healthcare Provider Details

I. General information

NPI: 1194817395
Provider Name (Legal Business Name): FRANCIS C BOUCEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 9TH ST N SUITE 300
NAPLES FL
34102-5820
US

IV. Provider business mailing address

399 9TH ST N SUITE 300
NAPLES FL
34102-5820
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-4200
  • Fax: 239-624-4201
Mailing address:
  • Phone: 239-624-4200
  • Fax: 239-624-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0022648
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: