=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396755757
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY M LENTZ MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7431 GLADIOLUS DR
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-689-7000
-----------------------------------------------------
Fax | 239-689-7007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7159 COTTONTAIL CT
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33908-5501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-489-3166
-----------------------------------------------------
Fax | 239-489-3166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | ME69159
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------