Organization
FORT MYERS CENTRE FOR FACIAL PLASTIC AND LASER SURGERY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS M STEVENS MD (DOCTOR)
(239) 481-4911
Entity
Organization
Contact information
Practice address
15721 NEW HAMPSHIRE CT, FORT MYERS, FL 33908-4176
(239) 481-4911
(239) 481-6360
Mailing address
15721 NEW HAMPSHIRE CT, FORT MYERS, FL 33908-4176
(239) 481-4911
(239) 481-6360
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME0068103
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040012514
RAILROAD MEDICARE
FL
01
—
32891
BCBS
FL
01
—
5091536
AETNA
FL
Enumeration date
10/22/2007
Last updated
09/23/2009
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