Provider Demographics
NPI:1275152399
Name:BOGATY, ELIZABETH JOYCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JOYCE
Last Name:BOGATY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-468-0254
Mailing Address - Fax:239-343-3958
Practice Address - Street 1:19511 HIGHLAND OAKS DR STE 201
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-9712
Practice Address - Country:US
Practice Address - Phone:239-468-0254
Practice Address - Fax:239-343-3958
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME160696207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118955400Medicaid