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General NPI Number Information
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NPI Number | 1104259035
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Entity Type | Organization
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Legal Business Name | PHYSICIANS MEDICAL GROUP OF SOUTHWEST FLORIDA,LLC
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Dates
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Enumeration Date | 08/14/2013
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 3800 COLONIAL BLVD STE 200
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City | FORT MYERS
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State | FL
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Zip | 33966-1075
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Country | US
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Telephone | 239-936-1233
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Fax | 239-936-8576
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Provider Business Mailing Address
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Address Line | 3800 COLONIAL BLVD STE 200
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City | FORT MYERS
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State | FL
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Zip | 33966-1075
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Country | US
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Telephone | 239-936-1233
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Fax | 239-936-8576
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | BARRY K BUTLER
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Credential | MD
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Telephone | 239-936-1233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS002373
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License Number State | FL
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