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General NPI Number Information
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NPI Number | 1528450632
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOCIATES OF SWFL PA
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 05/14/2015
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Provider Practice Location Address
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Address Line | 1008 GOODLETTE RD N SUITE 100
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City | NAPLES
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State | FL
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Zip | 34102-5406
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Country | US
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Telephone | 239-325-2086
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 GOODLETTE RD N SUITE 100
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City | NAPLES
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State | FL
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Zip | 34102-5406
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | REISHA BROWN
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Credential | MD
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Telephone | 239-404-3211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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