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General NPI Number Information
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NPI Number | 1154796126
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Entity Type | Organization
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Legal Business Name | NMS WEIGHTLOSS CLINIC I LLC
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Dates
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Enumeration Date | 12/02/2015
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Last Update Date | 12/02/2015
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Provider Practice Location Address
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Address Line | 6150 DIAMOND CENTRE CT BLDG #400
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City | FORT MYERS
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State | FL
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Zip | 33912-4368
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Country | US
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Telephone | 239-333-0828
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Fax | 239-561-9188
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Provider Business Mailing Address
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Address Line | 6150 DIAMOND CENTRE CT BLDG #400
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City | FORT MYERS
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State | FL
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Zip | 33912-4368
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Country | US
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Telephone | 239-333-0828
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Fax | 239-561-9188
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Authorized Official
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Title or Position | CFO
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Name | MR. PETER BLOY
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Credential |
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Telephone | 239-333-0828
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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 | L06000097103
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License Number State | FL
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