Provider Demographics
NPI:1376680041
Name:SANIBEL MEDICAL, INC.
Entity Type:Organization
Organization Name:SANIBEL MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:N
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-395-2005
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:SANIBEL
Mailing Address - State:FL
Mailing Address - Zip Code:33957-0628
Mailing Address - Country:US
Mailing Address - Phone:239-395-2005
Mailing Address - Fax:239-395-0042
Practice Address - Street 1:2499 PALM RIDGE RD
Practice Address - Street 2:
Practice Address - City:SANIBEL
Practice Address - State:FL
Practice Address - Zip Code:33957-3201
Practice Address - Country:US
Practice Address - Phone:239-395-2005
Practice Address - Fax:239-395-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG39000Medicare UPIN