Organization
ISLAND FACIAL PLASTIC AND ENT SURGERY, PA
Active
Other names
J Bertrand Davis MD FACS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN BERTRAND DAVIS MD (CEO/PRES)
(239) 481-9211
Entity
Organization
Contact information
Practice address
9981 S HEALTHPARK DR, SUITE 259, FORT MYERS, FL 33908-3618
(239) 481-9211
(239) 481-7568
Mailing address
9981 S HEALTHPARK DR, SUITE 259, FT MYERS, FL 33908-3618
(239) 481-9211
(239) 481-7568
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0039739
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11986
BC/BS
FL
Enumeration date
08/28/2006
Last updated
05/15/2012
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