Organization
CHARLES S EBY MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES SIDNEY EBY JR. MD (MEDICAL DIRECTOR)
(239) 936-1145
Entity
Organization
Contact information
Practice address
2666 SWAMP CABBAGE CT, FORT MYERS, FL 33901-9332
(239) 936-1145
(239) 275-5074
Mailing address
2666 SWAMP CABBAGE CT, FORT MYERS, FL 33901-9332
(239) 936-1145
(239) 275-5074
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME15824
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K7316
MEDICARE GROUP NUMBER
FL
Enumeration date
06/09/2008
Last updated
06/09/2008
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