=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386940757
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUGHES FAMILY PRACTICE PL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2011
-----------------------------------------------------
Last Update Date | 06/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13731 METROPOLIS AVE
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33912-7150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-561-5776
-----------------------------------------------------
Fax | 239-333-1953
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 449
-----------------------------------------------------
City | ESTERO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33929-0449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-561-5776
-----------------------------------------------------
Fax | 239-333-1953
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DOUGLAS STEPHEN HUGHES
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 239-561-5776
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS9442
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------