MEDICARE: LEA MOREEN BLACKWELL MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208600000X	Surgery Physician	ME102649	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00657339	OTHER	FL	RAILROAD MEDICARE

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	0172805	OTHER	FL	CIGNA
4	463262	OTHER	FL	WELLCARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356508410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEA MOREEN BLACKWELL MD

Provider Business Mailing Address
First Line	:	6321 DANIELS PKWY STE 200
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4773
Country	:	US
Telephone Number	:	941-626-1530
Fax Number	:

Provider Business Practice Location Address
First Line	:	13691 METRO PKWY STE 300
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4322
Country	:	US
Telephone Number	:	239-264-1236
Fax Number	:	321-359-7055

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

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	06/27/2023

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Directions to “ LEA MOREEN BLACKWELL MD” Practice Location

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