1760405468 NPI number — DR. DAVID R DRIESBACH DO

Table of content: DR. DAVID R DRIESBACH DO (NPI 1760405468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760405468 NPI number — DR. DAVID R DRIESBACH DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRIESBACH
Provider First Name:
DAVID
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760405468
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5106 KENSINGTON HIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34105-5648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-213-0094
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
643 CAPE CORAL PKWY E
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
CAPE CORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33904-8549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-540-4500
Provider Business Practice Location Address Fax Number:
239-540-1952
Provider Enumeration Date:
07/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS00006995 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 192325 . This is a "STAYWELL HEALTHYKIDS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1188691 . This is a "CIGNA HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 57245 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: OS00006995 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".