Provider Demographics
NPI:1285667907
Name:WILLIAM D. ERTAG, MD P.A.
Entity Type:Organization
Organization Name:WILLIAM D. ERTAG, MD P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ZARANEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-430-0800
Mailing Address - Street 1:720 GOODLETTE RD N
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5656
Mailing Address - Country:US
Mailing Address - Phone:239-430-0800
Mailing Address - Fax:239-430-0538
Practice Address - Street 1:720 GOODLETTE RD N
Practice Address - Street 2:SUITE 204
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5656
Practice Address - Country:US
Practice Address - Phone:239-430-0800
Practice Address - Fax:239-430-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME253712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58430Medicare UPIN
FL78279BMedicare ID - Type Unspecified