Provider Demographics
NPI:1528376126
Name:RICARDO E. NOVOA, D.O., P.A.
Entity Type:Organization
Organization Name:RICARDO E. NOVOA, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:NOVOA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-482-7765
Mailing Address - Street 1:13440 PARKER COMMONS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1816
Mailing Address - Country:US
Mailing Address - Phone:239-482-7765
Mailing Address - Fax:239-432-9392
Practice Address - Street 1:13440 PARKER COMMONS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1816
Practice Address - Country:US
Practice Address - Phone:239-482-7765
Practice Address - Fax:239-432-9392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE93415Medicare UPIN