Provider Demographics
NPI:1376092973
Name:MIDDLETON, DAVID SEAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:SEAN
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9711 COMMERCE CENTER CT STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3817
Mailing Address - Country:US
Mailing Address - Phone:239-939-2621
Mailing Address - Fax:239-939-3875
Practice Address - Street 1:9711 COMMERCE CENTER CT STE 101
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3817
Practice Address - Country:US
Practice Address - Phone:239-939-2621
Practice Address - Fax:239-939-3875
Is Sole Proprietor?:No
Enumeration Date:2016-09-25
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109807363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
21549AOtherGROUP MEDICARE
FLPH419OtherPROVIDER MEDICARE
FLP1046724OtherFREEDOM
FL019216900Medicaid
FL4338069OtherAETNA
FL398584OtherAVMED
FL1417683OtherWELLCARE-MEDICARE/MEDICAID
FLP979953OtherOPTIMUM
FL1417683OtherWELLCARE-MEDICARE/MEDICAID