Provider Demographics
NPI:1467439810
Name:POELTL, DAVID E (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:POELTL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:661 GOODLETTE RD N
Mailing Address - Street 2:STE 105
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5609
Mailing Address - Country:US
Mailing Address - Phone:239-262-6288
Mailing Address - Fax:239-262-5434
Practice Address - Street 1:661 GOODLETTE RD N
Practice Address - Street 2:STE 105
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5609
Practice Address - Country:US
Practice Address - Phone:239-262-6288
Practice Address - Fax:239-262-5434
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2009-05-27
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Provider Licenses
StateLicense IDTaxonomies
FLME57757207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15122OtherBLUE CROSS BLUE SHIELD
F29122Medicare UPIN
15122ZMedicare PIN
180013833Medicare PIN