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General NPI Number Information
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NPI Number | 1295997971
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Entity Type | Organization
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Legal Business Name | JOHN MICHAEL POIRIER PA
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 1364 ALCAZAR AVE
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City | FORT MYERS
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State | FL
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Zip | 33901-6617
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Country | US
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Telephone | 239-332-4293
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Fax | 239-332-4297
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Provider Business Mailing Address
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Address Line | PO BOX 07283
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City | FORT MYERS
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State | FL
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Zip | 33919-0283
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Country | US
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Telephone | 239-332-4293
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Fax | 239-332-4297
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN MICHAEL POIRIER
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Credential | PH.D.
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Telephone | 239-332-4293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY0005547
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License Number State | FL
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