Island Facial Plastic and ENT Surgery, PA

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0039739 Issued in FL

Legal business name

ISLAND FACIAL PLASTIC AND ENT SURGERY, PA

Practice address

9981 S Healthpark Dr
Suite 259
Fort Myers, FL 33908-3618

Phone

(239) 481-9211

Fax

(239) 481-7568

NPI assigned

Aug 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John Bertrand Davis, MD

Title

Ceo/Pres

Phone

(239) 481-9211

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• J Bertrand Davis MD FACS Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337040000000",
    "number": "1144338302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9981 S HEALTHPARK DR",
            "address_2": "SUITE 259",
            "city": "FT MYERS",
            "state": "FL",
            "postal_code": "339083618",
            "telephone_number": "239-481-9211",
            "fax_number": "239-481-7568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9981 S HEALTHPARK DR",
            "address_2": "SUITE 259",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339083618",
            "telephone_number": "239-481-9211",
            "fax_number": "239-481-7568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND FACIAL PLASTIC AND ENT SURGERY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-28",
        "last_updated": "2012-05-15",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "BERTRAND",
        "authorized_official_title_or_position": "CEO/PRES",
        "authorized_official_telephone_number": "239-481-9211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "0039739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "11986",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "J Bertrand Davis MD FACS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Island Coast Behavioral Health and Therapy LLC
• Island Coast Dermatology, PA
• Island Coast Pediatrics
• Island Coast Primary Care Project, Inc.
• Island Coast Primary Care Project, Inc.
• Island Park Psychiatry LLC
• Island Wellness Clinic
• Laura Michelle Isley, M.D.
• Jelin N Israel-Cvik, M.D.
• Ivan Sava Itebejac, PHARM.D.

• Ambulatory Surgical Clinic/Center in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.