Organization
R PAUL LICCINI MD LLC
Active
Organization
R PAUL LICCINI MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. R. PAUL LICCINI M.D. (OWNER)
(239) 936-2220
Entity
Organization
Contact information
Practice address
12645 NEW BRITTANY BLVD, BLDG 15, FORT MYERS, FL 33907-3631
(239) 936-2220
(239) 936-2444
Mailing address
12645 NEW BRITTANY BLVD, BLDG 15, FORT MYERS, FL 33907-3631
(239) 936-2220
(239) 936-2444
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DG1282
RAIL ROAD MEDICARE
FL
Enumeration date
04/19/2006
Last updated
07/29/2010
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