Organization
EDWARD FETHEROLF M D P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD C FETHEROLF M.D. (PRESIDENT)
(941) 474-2266
Entity
Organization
Contact information
Practice address
1500 PLACIDA RD, SUITE B2, ENGLEWOOD, FL 34223-4955
(941) 474-2266
(941) 475-7274
Mailing address
1500 PLACIDA RD, SUITE B2, ENGLEWOOD, FL 34223-4955
(941) 474-2266
(941) 475-7274
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME30596
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
374759000
—
FL
Enumeration date
10/22/2007
Last updated
05/13/2015
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