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General NPI Number Information
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NPI Number | 1477928810
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Entity Type | Organization
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Legal Business Name | NMS WEIGHTLOSS CLINIC II LLC
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 12/10/2015
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Provider Practice Location Address
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Address Line | 90 CYPRESS WAY E SUITE 45
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City | NAPLES
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State | FL
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Zip | 34110-9275
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Country | US
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Telephone | 239-325-1633
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Fax | 239-325-1630
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Provider Business Mailing Address
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Address Line | 6150 DIAMOND CENTRE COURT BLDG #400
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City | FORT MYERS
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State | FL
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Zip | 33912
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Country | US
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Telephone | 239-333-0828
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Fax | 239-561-9188
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Authorized Official
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Title or Position | CFO
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Name | PETER BLOY
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Credential |
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Telephone | 239-333-0828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L07000111368
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License Number State | FL
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