Ft Myers Physician PA

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

ME36712 Issued in FL

Legal business name

FT MYERS PHYSICIAN PA

Practice address

2721 Del Prado Blvd S
Suite 240
Cape Coral, FL 33904-5781

Phone

(239) 333-0084

Fax

(239) 333-0086

NPI assigned

Jan 10, 2007

Last updated

Apr 20, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dana Gerald Killam, M.D.

Title

President

Phone

(239) 333-0084

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1437209855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2721 DEL PRADO BLVD S",
            "address_2": "SUITE 240",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339045781",
            "telephone_number": "239-333-0084",
            "fax_number": "239-333-0086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2721 DEL PRADO BLVD S",
            "address_2": "SUITE 240",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339045781",
            "telephone_number": "239-333-0084",
            "fax_number": "239-333-0086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FT MYERS PHYSICIAN PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "KILLAM",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "GERALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-333-0084",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME36712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sheila Diane Frost, LMHC
• Stephanie Fry, RN, RD, LDN, CDCES
• Ariel Fucien, PHARMD
• Liyanni Fuentes Bernal
• Orelbe Fuentes Cabrera
• Dianis Fuentes Curbelo
• Rocio Fuentes Martinez

• Emergency Medicine Physician in Cape Coral, FL
• Providers in Cape Coral, FL by specialty
• Emergency Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.