=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427046846
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHOPEDIC ASSOCIATES OF SOUTHWEST FLORIDA PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2005
-----------------------------------------------------
Last Update Date | 10/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13691 METRO PKWY SUITE 400
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33912-4327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-768-2272
-----------------------------------------------------
Fax | 239-768-5549
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13691 METRO PKWY SUITE 400
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33912-4327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-768-2272
-----------------------------------------------------
Fax | 239-768-5549
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | EDWARD R DUPAY JR.
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 239-768-2272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | OS4788
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------