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General NPI Number Information
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NPI Number | 1437100146
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN NEPHROLOGY BUTCHER & DEVACAANTHAN MD PA
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 7981 GLADIOLUS DR.
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City | FORT MYERS
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State | FL
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Zip | 33908-4154
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Country | US
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Telephone | 239-939-0999
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Fax | 239-939-1070
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Provider Business Mailing Address
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Address Line | 7981 GLADIOLUS DR
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City | FORT MYERS
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State | FL
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Zip | 33908-4154
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Country | US
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Telephone | 239-939-0999
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Fax | 239-939-1070
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Authorized Official
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Title or Position | MD
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Name | MARY M MOURACADE
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Credential | MD
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Telephone | 239-939-0999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 4680129492717
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License Number State | FL
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