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General NPI Number Information
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NPI Number | 1386786838
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ORTHOPEDICS OF SOUTHWEST FLORIDA
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15821 HOLLYFERN COURT
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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 | 239-432-5100
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Fax | 239-432-5135
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Provider Business Mailing Address
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Address Line | 15880 SUMMERLIN RD STE 300 PMB 322
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City | FORT MYERS
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State | FL
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Zip | 33908-9612
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Country | US
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Telephone | 239-432-5100
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Fax | 239-432-5135
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | ANNETTE L MURRAY
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Credential |
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Telephone | 239-432-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | OS4993
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License Number State | FL
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