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General NPI Number Information
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NPI Number | 1770606956
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Entity Type | Organization
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Legal Business Name | PEDIATRIC NEUROLOGY OF SW FL, PA
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 02/23/2008
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Provider Practice Location Address
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Address Line | 15740 NEW HAMPSHIRE CT SUITE B
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City | FORT MYERS
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State | FL
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Zip | 33908-4173
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Country | US
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Telephone | 239-433-9383
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Fax | 239-433-9356
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Provider Business Mailing Address
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Address Line | 15880 SUMMERLIN RD SUITE 300 PMB 178
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City | FORT MYERS
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State | FL
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Zip | 33908-9612
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Country | US
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Telephone | 239-433-9383
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Fax | 239-433-9356
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARGIE MORALES
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Credential | M.D.
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Telephone | 239-433-9383
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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 | ME51721
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License Number State | FL
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