Healthcare Provider Details

I. General information

NPI: 1275933491
Provider Name (Legal Business Name): NUKE ME, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 SAND DOLLAR DR
SANIBEL FL
33957-7005
US

IV. Provider business mailing address

821 SAND DOLLAR DR
SANIBEL FL
33957-7005
US

V. Phone/Fax

Practice location:
  • Phone: 239-823-0057
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberME51842
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberME51842
License Number StateFL

VIII. Authorized Official

Name: ROBERT J MCDONALD
Title or Position: OWNER
Credential: MD
Phone: 239-325-2086