Provider Demographics
NPI:1073889028
Name:NAPLES GYNECOLOGY LLC
Entity Type:Organization
Organization Name:NAPLES GYNECOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BLANE
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:CRANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-213-9111
Mailing Address - Street 1:1012 GOODLETTE RD N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5463
Mailing Address - Country:US
Mailing Address - Phone:239-214-9111
Mailing Address - Fax:239-330-1360
Practice Address - Street 1:1012 GOODLETTE RD N
Practice Address - Street 2:SUITE 101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5463
Practice Address - Country:US
Practice Address - Phone:239-214-9111
Practice Address - Fax:239-330-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95903207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01893701OtherBLUE CROSS BLUE SHIELD