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General NPI Number Information
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NPI Number | 1255436143
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Entity Type | Organization
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Legal Business Name | FORT MYERS FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 15661 SAN CARLOS BLVD SUITE 2
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City | FORT MYERS
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State | FL
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Zip | 33908
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Country | US
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Telephone | 239-433-4014
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Fax | 239-481-6247
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Provider Business Mailing Address
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Address Line | 15661 SAN CARLOS BLVD SUITE 2
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City | FORT MYERS
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State | FL
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Zip | 33908-2797
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Country | US
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Telephone | 239-433-4014
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Fax | 239-481-6247
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Authorized Official
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Title or Position | EXECUTIVE MANAGING DIRECTOR
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Name | DR. HURSEL LEE ADKINS JR.
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Credential | D.O
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Telephone | 239-433-4014
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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 | OS0005720
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License Number State | FL
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