Organization
FORT MYERS DERMATOPATHOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MAZEN DAOUD MD (PRESIDENT)
(239) 274-0005
Entity
Organization
Contact information
Practice address
8381 RIVERWALK PARK BLVD, SUITE 202, FT MYERS, FL 33919
(239) 274-0005
(239) 274-8185
Mailing address
8381 RIVERWALK PARK BLVD, SUITE 202, FT MYERS, FL 33919
(239) 274-0005
(239) 274-8185
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06492
BCBS
FL
01
—
202599
WELLCARE
FL
01
—
202599
WELLCARE STAYWELL
—
01
—
284777
AVMED
—
Enumeration date
04/25/2006
Last updated
08/22/2020
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