1558617589 NPI number — DR. JOSHUA CRAIG MORROW D.M.D.

Table of content: (NPI 1992847982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558617589 NPI number — DR. JOSHUA CRAIG MORROW D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORROW
Provider First Name:
JOSHUA
Provider Middle Name:
CRAIG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
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:
1558617589
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1357
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33902-1357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-278-3600
Provider Business Mailing Address Fax Number:
239-226-4650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 LEE BLVD
Provider Second Line Business Practice Location Address:
SUITES 103 & 104
Provider Business Practice Location Address City Name:
LEHIGH ACRES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33971-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-344-2385
Provider Business Practice Location Address Fax Number:
239-368-0288
Provider Enumeration Date:
07/27/2012

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: 1223G0001X , with the licence number:  DN19895 , 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: 006451200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com