1972519924 NPI number — DR. MELWYN S D'SOUZA MD

Table of content: DR. MELWYN S D'SOUZA MD (NPI 1972519924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972519924 NPI number — DR. MELWYN S D'SOUZA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
D'SOUZA
Provider First Name:
MELWYN
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1972519924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13440 PARKER COMMONS BLVD
Provider Second Line Business Mailing Address:
SUITE NUMBER 105
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33912-1816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-225-6304
Provider Business Mailing Address Fax Number:
239-225-6303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13440 PARKER COMMONS BLVD
Provider Second Line Business Practice Location Address:
SUITE NUMBER 105
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33912-1816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-225-6304
Provider Business Practice Location Address Fax Number:
239-225-6303
Provider Enumeration Date:
07/31/2006

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: 207R00000X , with the licence number:  ME89047 , 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: 101704400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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