Organization
MEDICAL CENTRE OF FORT MYERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEMETRIS WEAVER PRESIDENT (PRESIDENT)
(813) 252-6114
Entity
Organization
Contact information
Practice address
4901 PALM BEACH BLVD STE 101, FORT MYERS, FL 33905-3252
(813) 252-6114
Mailing address
4901 PALM BEACH BLVD STE 101, FORT MYERS, FL 33905-3252
(813) 252-6114
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
2084P0802X
Addiction Psychiatry Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM2800X
Methadone Clinic
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
10/11/2021
Last updated
10/20/2021
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