Active NPI
J. Robert South, PA
- Physician Assistant
- Fort Myers, FL
National Provider Identifier
1477563542
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA1641
- Practice address
- 3920 Michigan Ave
Fort Myers, FL 33916-2205 - Phone
- (239) 332-9501
- Fax
- (239) 332-9553
- NPI assigned
- Aug 9, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA1641 | FL | Primary |
Addresses
Primary practice location
3920 Michigan Ave
Fort Myers, FL 33916-2205
Mailing address
3920 Michigan Ave
Fort Myers, FL 33916-2205
Phone (239) 332-9501
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA1641 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Florida Department of Health | Past | Accepting new patients | |
| Florida Department of Health | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Public Health or Welfare Agency
- Fort Myers, FL
- NPI 1154392686
-
- Public Health or Welfare Agency
- Bronson, FL
- NPI 1154395390
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1477563542",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3920 MICHIGAN AVE",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339162205",
"telephone_number": "239-332-9501",
"fax_number": "239-332-9553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3920 MICHIGAN AVE",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339162205",
"telephone_number": "239-332-9501",
"fax_number": "239-332-9553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUTH",
"first_name": "J. ROBERT",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA1641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Myers, FL
- Soundmind Music Therapy Inc.
- Jaqueline Sousa Carvalho, FNP-BC
- South Florida Rehab & Spa
- South Florida Surgical Associates, LLC
- South Gulf Coast Emergency Physicians PA
- Southeast Hospice Equipment Company Inc
- Southen Oaks Senior Living Care LLC
- Southern Magnolia LLC
- Southwest Florida Addiction Service
- Southwest Florida Anesthesia Plus
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.