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NPI Code Detail

MEDICARE: ENDOCRINE SPECIALIST PA

MEDICARE: ENDOCRINE SPECIALIST PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RE0101XEndocrinology, Diabetes & Metabolism PhysicianME73670FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1460002821OTHERRR CARE
242327OTHERFLBCBS

General Provider Information

NPI Number : 1144399932
Entity Type Code : Organization
Provider Name (Legal Business Name) : ENDOCRINE SPECIALIST PA
Provider Business Mailing Address
First Line : 730 GOODLETTE ROAD NORTH
Second Line : SUITE 205
City : NAPLES
State : FL
Zip : 34102-5618
Country : US
Telephone Number : 239-436-3666
Fax Number : 239-436-3678
Provider Business Practice Location Address
First Line : 730 GOODLETTE ROAD NORTH
Second Line : SUITE 205
City : NAPLES
State : FL
Zip : 34102-5618
Country : US
Telephone Number : 239-436-3666
Fax Number : 239-436-3678
Authorized Official
Title or Position : PRESIDENT
Name : DR. TODD D BRODIE
Credential : M.D.
Telephone Number : 239-436-3666
Provider Enumeration Date : 11/07/2006
Last Update Date : 11/07/2016

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