Organization
DEBRA TODD BLACK, D.O., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RENEE JEAN RICHARDS (OFFICE MANAGER)
(239) 432-9383
Entity
Organization
Contact information
Practice address
13440 PARKER COMMONS BLVD, SUITE 101, FORT MYERS, FL 33912-1816
(239) 432-9383
(239) 432-9392
Mailing address
13440 PARKER COMMONS BLVD, SUITE 101, FORT MYERS, FL 33912-1816
(239) 432-9383
(239) 432-9392
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS5735
FL
Other
Enumeration date
01/13/2011
Last updated
01/13/2011
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