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General NPI Number Information
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NPI Number | 1700988813
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Entity Type | Organization
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Legal Business Name | FRED J BURFORD, II DO, PA
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 03/19/2010
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Provider Practice Location Address
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Address Line | 6120 WINKER RD SUITE H
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City | FORT MYERS
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State | FL
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Zip | 33919
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Country | US
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Telephone | 239-337-9422
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Fax | 239-337-9421
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Provider Business Mailing Address
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Address Line | P.O. BOX 07267
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City | FORT MYERS
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State | FL
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Zip | 33919-0267
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Country | US
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Telephone | 239-337-9422
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Fax | 239-337-9421
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TIFFANY A CUMBESS
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Credential |
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Telephone | 239-337-9422
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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 | OS5829
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License Number State | FL
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