Healthcare Provider Details

I. General information

NPI: 1225036213
Provider Name (Legal Business Name): NAPLES PEDIATRICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 PARK CENTRAL CT
NAPLES FL
34109-5923
US

IV. Provider business mailing address

5400 PARK CENTRAL CT SUITE 2
NAPLES FL
34109-6001
US

V. Phone/Fax

Practice location:
  • Phone: 239-593-7000
  • Fax: 239-593-7008
Mailing address:
  • Phone: 239-593-7000
  • Fax: 239-593-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0065935
License Number StateFL

VIII. Authorized Official

Name: DR. PAUL ROBERT IRRA
Title or Position: OWNER
Credential: M.D.
Phone: 239-593-7000