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NPI Code Detail

MEDICARE: MR. JOHN PETER KMETZ P.A.

MEDICARE:  MR. JOHN PETER KMETZ  P.A.
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
1363AS0400XSurgical Physician AssistantPA1731FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13464527OTHERFLCIGNA
236291OTHERFLBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
49423471OTHERFLAETNA
5PA0001731OTHERFLPA LICENSE
61902843352OTHERFLTRICARE

General Provider Information

NPI Number : 1902843352
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOHN PETER KMETZ P.A.
Provider Business Mailing Address
First Line : 3033 WINKLER AVE UNIT 100
Second Line :
City : FORT MYERS
State : FL
Zip : 33916-9523
Country : US
Telephone Number : 239-277-7070
Fax Number : 239-277-7071
Provider Business Practice Location Address
First Line : 3033 WINKLER AVE UNIT 100
Second Line :
City : FORT MYERS
State : FL
Zip : 33916-9523
Country : US
Telephone Number : 239-277-7070
Fax Number : 239-277-7071
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2006
Last Update Date : 11/29/2018

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Directions to “ MR. JOHN PETER KMETZ P.A.” Practice Location

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