Provider Demographics
NPI:1437555497
Name:TOMAS V FACTORA, MD
Entity Type:Organization
Organization Name:TOMAS V FACTORA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:FACTORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-267-2525
Mailing Address - Street 1:18070 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 8
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4602
Mailing Address - Country:US
Mailing Address - Phone:239-267-2525
Mailing Address - Fax:239-267-2434
Practice Address - Street 1:18070 S TAMIAMI TRL
Practice Address - Street 2:SUITE 8
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4602
Practice Address - Country:US
Practice Address - Phone:239-267-2525
Practice Address - Fax:239-267-2434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53635261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC53846Medicare UPIN