MEDICARE: WAYNE ISAACSON M.D.

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
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME71098	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	32138	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1215928189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE ISAACSON M.D.

Provider Business Mailing Address
First Line	:	4035 EVANS AVE
Second Line	:	SUITE 1
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9308
Country	:	US
Telephone Number	:	239-939-7375
Fax Number	:	239-939-5105

Provider Business Practice Location Address
First Line	:	4035 EVANS AVE
Second Line	:	SUITE 1
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9308
Country	:	US
Telephone Number	:	239-939-7375
Fax Number	:	239-939-5105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	10/21/2016

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