Organization
SOUTHWEST FLORIDA FERTILITY CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACOB LEON GLOCK MEDICAL DOCTOR MD (PRESIDENT)
(239) 561-3430
Entity
Organization
Contact information
Practice address
15730 NEW HAMPSHIRE CT, SUITE 101, FORT MYERS, FL 33908
(239) 561-3430
(239) 561-6980
Mailing address
15730 NEW HAMPSHIRE CT, SUITE 101, FORT MYERS, FL 33908
(239) 561-3430
(239) 561-6980
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
ME0057264
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
379285400
—
FL
01
—
ME0057264
FLORIDA STATE LICENSE
FL
Enumeration date
10/26/2006
Last updated
01/12/2009
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