1205093549 NPI number — JOHN D STRAUSBAUGH DO PA

Table of content: HOI LING LING CHU (NPI 1568007219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205093549 NPI number — JOHN D STRAUSBAUGH DO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN D STRAUSBAUGH DO PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1205093549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9671 GLADIOLUS DR
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33908-7684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-362-1450
Provider Business Mailing Address Fax Number:
239-985-9629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9671 GLADIOLUS DR
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33908-7684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-362-1450
Provider Business Practice Location Address Fax Number:
239-985-9629
Provider Enumeration Date:
05/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STRAUSBAUGH
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
DEAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
239-362-1450

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS4468 , 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: 1821086240 . This is a "NPI INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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