Organization
CAPE CORAL EMERGENCY PHYSICIANS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY DOUGHERTY M. D. (MEDICAL DIRECTOR)
(239) 424-3513
Entity
Organization
Contact information
Practice address
636 DEL PRADO BLVD S, CAPE CORAL, FL 33990-2668
(239) 772-6513
Mailing address
PO BOX 9536, DAYTONA BEACH, FL 32120-9536
(386) 274-7800
(833) 547-6530
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371517500
—
FL
01
—
39365
BLUE CROSS BLUE SHIELD
FL
01
—
8206735
AETNA
FL
01
—
CPCR
AMERIGROUP
FL
Enumeration date
12/01/2006
Last updated
09/17/2021
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