Individual
DR. LAWRENCE RICHARD BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
13691 METRO PKWY, 350, FORT MYERS, FL 33912-4327
(239) 768-5313
(239) 768-9559
Mailing address
2234 COLONIAL BLVD, ATTN: PAYER CONTRACTING & RELATIONS, FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
055736
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007256700
—
FL
01
—
15649
WELLCARE
FL
01
—
212724
AVMED
FL
01
—
2972830
CIGNA
FL
05
—
375522300
—
FL
01
—
4478694
AETNA
FL
01
—
80628
BCBS
FL
01
—
P01192863
RAILROAD MCR
FL
01
—
P304402
FREEDOM HEALTH
FL
01
—
P946386
OPTIMUM
FL
Enumeration date
08/28/2006
Last updated
04/25/2016
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