Provider Demographics
NPI:1104007087
Name:JOHN D MUIR MD FACP
Entity Type:Organization
Organization Name:JOHN D MUIR MD FACP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DOUGLASS
Authorized Official - Last Name:MUIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACP
Authorized Official - Phone:239-591-8900
Mailing Address - Street 1:11181 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE 2260
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-5738
Mailing Address - Country:US
Mailing Address - Phone:239-591-8900
Mailing Address - Fax:239-514-7792
Practice Address - Street 1:11181 HEALTH PARK BLVD
Practice Address - Street 2:SUITE 2260
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110
Practice Address - Country:US
Practice Address - Phone:239-591-8900
Practice Address - Fax:239-514-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060704174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0060704 FLOtherMEDICAL LICENSE NUMBER
FL174400000XOtherPROVIDER TAXONOMIES
FLB38069Medicare UPIN