# DEBRA TODD BLACK, D.O., P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083919500
- **Authorized official:** MRS. RENEE JEAN RICHARDS (OFFICE MANAGER)
- **Authorized official phone:** (239) 432-9383

## Contact information

- **Practice address:** 13440 PARKER COMMONS BLVD, SUITE 101, FORT MYERS, FL 33912-1816
- **Practice address phone:** (239) 432-9383
- **Practice address fax:** (239) 432-9392
- **Mailing address:** 13440 PARKER COMMONS BLVD, SUITE 101, FORT MYERS, FL 33912-1816
- **Mailing address phone:** (239) 432-9383
- **Mailing address fax:** (239) 432-9392

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | OS5735 | FL | Yes |

## Other

- **Enumeration date:** 01/13/2011
- **Last updated:** 01/13/2011