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Contact Information

FORT MYERS DERMATOPATHOLOGY PA
8381 RIVERWALK PARK BLVD
SUITE 202
FORT MYERS, FL33919
 Phone: 239-274-0005
 Fax: 239-274-8185
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatopathology

207ND0900X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for FORT MYERS DERMATOPATHOLOGY PA

NPI Number 1013973320
LBN Legal business name FORT MYERS DERMATOPATHOLOGY PA
Authorized official MAZEN DAOUD - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 04/25/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
Other 284777 AVMED
Other 202599 WELLCARE STAYWELL
FL Other 06492 BCBS
FL Other 202599 WELLCARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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