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General NPI Number Information
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NPI Number | 1225093941
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Entity Type | Organization
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Legal Business Name | CAPE CORAL EMERGENCY PHYSICIANS
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 10/17/2007
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Provider Practice Location Address
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Address Line | 636 DEL PRADO BLVD S
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City | CAPE CORAL
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State | FL
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Zip | 33990-2668
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Country | US
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Telephone | 239-772-6513
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Fax |
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Provider Business Mailing Address
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Address Line | 6896 W SNOWVILLE RD
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City | BRECKSVILLE
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State | OH
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Zip | 44141-3214
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | TIMOTHY DOUGHERTY
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Credential |
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Telephone | 239-772-6513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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