Susan D McCullum, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME86366 Issued in FL

Practice address

2232 Grand Ave
Fort Myers, FL 33901-3717

Phone

(239) 344-2341

Fax

(239) 334-7518

NPI assigned

Nov 2, 2005

Last updated

Apr 30, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272585600000",
    "number": "1578554291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1357",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339021357",
            "telephone_number": "239-278-3600",
            "fax_number": "239-278-3857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2232 GRAND AVE",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339013717",
            "telephone_number": "239-344-2341",
            "fax_number": "239-334-7518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLUM",
        "first_name": "SUSAN",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2010-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME86366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED",
            "identifier": "1483313",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7768378",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265855100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "62808",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John D McCoy, MHS
• Richard McCoy, LDO
• Kierra Watson McCrary
• John McCue, ARNP
• Jocee McCullar
• William Hanes McCuskey, M.D.
• Karla McDaniel
• Noelle McDaniel, PA
• Deverene Megan McDonald
• Jennifer McDonald

• Pediatrics Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2010; 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.