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General NPI Number Information
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NPI Number | 1780874784
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Entity Type | Organization
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Legal Business Name | ADVANCED LAPAROSCOPIC SURGERY OF FORT MYERS LLC
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 07/23/2009
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Provider Practice Location Address
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Address Line | 615 WILLIAMS AVE SUITE 101
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City | LEHIGH ACRES
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State | FL
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Zip | 33972-7954
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Country | US
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Telephone | 239-303-5273
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Fax | 866-586-6004
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Provider Business Mailing Address
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Address Line | 615 WILLIAMS AVE SUITE 101
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City | LEHIGH ACRES
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State | FL
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Zip | 33972-7954
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Country | US
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Telephone | 239-209-7543
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Fax | 866-586-6004
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK THOMAS MCGRAW
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Credential | M. D.
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Telephone | 239-209-7543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME96681
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License Number State | FL
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