Individual
NWE OO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
43 BARKLEY CIR STE 201, FORT MYERS, FL 33907-7518
(407) 620-8775
Mailing address
700 8TH AVE W STE 101, PALMETTO, FL 34221-4737
(941) 776-4000
(941) 845-4963
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
MD067262L
PA
2084P0800X
Psychiatry Physician
Primary
ME118929
FL
Other
Enumeration date
03/22/2007
Last updated
12/19/2017
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