MEDICARE: WAYNE ISAACSON 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	332900000X	Non-Pharmacy Dispensing Site	ME0071098	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1020685	OTHER		OTHER ID NUMBER
2	1020685	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1770698706
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE ISAACSON MD

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

Provider Business Practice Location Address
First Line	:	4035 EVANS AVE
Second Line	:	STE 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	:	MD
Name	:	WAYNE ISAACSON
Credential	:
Telephone Number	:	239-939-7375

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/31/2007

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