MEDICARE: FLORIDA NEUROLOGY GROUP

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	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1932318821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA NEUROLOGY GROUP

Provider Business Mailing Address
First Line	:	12670 WHITEHALL DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-3619
Country	:	US
Telephone Number	:	239-936-3554
Fax Number	:	239-936-8993

Provider Business Practice Location Address
First Line	:	1003 DEL PRADO BLVD
Second Line	:	SUITE 202
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3601
Country	:	US
Telephone Number	:	239-936-3554
Fax Number	:	239-936-8993

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MRS. DEBBIE ANN KING
Credential	:
Telephone Number	:	239-936-3554

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	10/31/2013

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