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General NPI Number Information
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NPI Number | 1487985610
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Entity Type | Organization
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Legal Business Name | ROYAL PALM MEDICAL GROUP INC
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 2665 CLEVELAND AVE STE 102
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City | FORT MYERS
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State | FL
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Zip | 33901-5884
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Country | US
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Telephone | 239-313-6300
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Fax | 239-689-5524
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Provider Business Mailing Address
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Address Line | 2665 CLEVELAND AVE STE 102
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City | FORT MYERS
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State | FL
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Zip | 33901-5884
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Country | US
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Telephone | 239-313-6300
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Fax | 239-689-5524
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Authorized Official
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Title or Position | OWNER
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Name | LAZARO GONZALEZ
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Credential | APRN
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Telephone | 239-313-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | MM24026
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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