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General NPI Number Information
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NPI Number | 1699757633
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Entity Type | Organization
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Legal Business Name | PHYSICIANS PRIMARY CARE OF SOUTHWEST FLORIDA PL
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 1265 VISCAYA PKWY
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City | CAPE CORAL
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State | FL
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Zip | 33990-3237
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Country | US
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Telephone | 239-573-7337
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Fax | 239-574-5883
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Provider Business Mailing Address
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Address Line | 12730 NEW BRITTANY BLVD STE 602
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City | FORT MYERS
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State | FL
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Zip | 33907-4690
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Country | US
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Telephone | 239-275-5522
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Fax | 239-275-4464
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Authorized Official
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Title or Position | MANAGING PHYSICIAN
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Name | DR. JON BURDZY
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Credential | DO
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Telephone | 239-275-5522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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