Individual
LEA MOREEN BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
13691 METRO PKWY STE 300, FORT MYERS, FL 33912-4322
(239) 264-1236
(321) 359-7055
Mailing address
6321 DANIELS PKWY STE 200, FORT MYERS, FL 33912-4773
(941) 626-1530
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME102649
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000373700
—
FL
01
—
0172805
CIGNA
FL
01
—
463262
WELLCARE
FL
01
—
P00657339
RAILROAD MEDICARE
FL
Enumeration date
05/16/2008
Last updated
06/27/2023
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