MEDICARE: DIGESTIVE SPECIALISTS 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
1	174400000X	Specialist		FL

General Provider Information

NPI Number	:	1962473140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGESTIVE SPECIALISTS P.A.

Provider Business Mailing Address
First Line	:	8380 RIVERWALK PARK BLVD
Second Line	:	SUITE 200
City	:	FORT MYERS
State	:	FL
Zip	:	33919-8758
Country	:	US
Telephone Number	:	239-561-7337
Fax Number	:	239-561-0244

Provider Business Practice Location Address
First Line	:	8380 RIVERWALK PARK BLVD
Second Line	:	SUITE 200
City	:	FORT MYERS
State	:	FL
Zip	:	33919-8758
Country	:	US
Telephone Number	:	239-561-7337
Fax Number	:	239-561-0244

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LESA SHAWLES
Credential	:
Telephone Number	:	239-561-7337

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	08/22/2020

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