Individual
ELIZABETH ANN DOUGLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
6385 PRESIDENTIAL CT, SUITE 102, FORT MYERS, FL 33919-3547
(239) 822-0973
Mailing address
19810 GOTTARDE RD, NORTH FORT MYERS, FL 33917-4563
(239) 822-0973
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA55210
FL
Other
Enumeration date
12/30/2008
Last updated
04/08/2009
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