Organization
SURGICAL CONSULTING GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID T RIDEOUT MD (PRESIDENT)
(207) 240-3362
Entity
Organization
Contact information
Practice address
3050 CHAMPION RING RD, FORT MYERS, FL 33905-5599
(941) 621-6577
Mailing address
PO BOX 511644, PUNTA GORDA, FL 33951-1644
(207) 240-3362
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME129811
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102201400
—
FL
Enumeration date
06/13/2018
Last updated
07/15/2021
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