Provider Demographics
NPI:1033103783
Name:QUERCI, JOHN C (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:QUERCI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 BONITA BEACH RD STE 310
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7836
Mailing Address - Country:US
Mailing Address - Phone:239-256-1609
Mailing Address - Fax:239-317-7012
Practice Address - Street 1:3301 BONITA BEACH RD STE 310
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7836
Practice Address - Country:US
Practice Address - Phone:239-256-1609
Practice Address - Fax:239-317-7012
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16473204D00000X, 208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7076455OtherCIGNA
FL826830Medicaid
PA91307OtherBLUE SHIELD
PA091307Medicare ID - Type Unspecified
PA000796734Medicaid