Active NPI
Jerry Steven Kantor, MD
- Psychiatry Physician
- Fort Myers, FL
National Provider Identifier
1184745705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- ME0042162
- Practice address
- 3949 Evans Avenue
Suite 203
Fort Myers, FL 33901 - Phone
- (239) 936-3202
- Fax
- (239) 936-4833
- NPI assigned
- Apr 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | ME0042162 | FL | Primary |
Addresses
Primary practice location
3949 Evans Avenue
Suite 203
Fort Myers, FL 33901
Mailing address
3949 Evans Avenue
Suite 203
Fort Myers, FL 33901
Phone (239) 936-3202
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 14, 2016 through Jan 14, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME0042162 | FL | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1184745705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3949 EVANS AVENUE",
"address_2": "SUITE 203",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "33901",
"telephone_number": "239-936-3202",
"fax_number": "239-936-4833"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3949 EVANS AVENUE",
"address_2": "SUITE 203",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "33901",
"telephone_number": "239-936-3202",
"fax_number": "239-936-4833"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANTOR",
"first_name": "JERRY",
"middle_name": "STEVEN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "FL",
"license": "ME0042162",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.