Provider Demographics
NPI:1194192443
Name:COOVERT, DAVID R (HAS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:COOVERT
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 SUMMERLIN RD STE C6
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3003
Mailing Address - Country:US
Mailing Address - Phone:239-703-7546
Mailing Address - Fax:239-339-9662
Practice Address - Street 1:4600 SUMMERLIN RD STE C6
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3003
Practice Address - Country:US
Practice Address - Phone:239-703-7546
Practice Address - Fax:239-533-9966
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4886237600000X
FLAS 4886237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105210300Medicaid