Provider Demographics
NPI:1578513826
Name:SAUNDERS, MARYBETH (DO)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:B
Other - Last Name:SAUNDERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9710
Mailing Address - Fax:239-343-9715
Practice Address - Street 1:9981 S HEALTHPARK DR
Practice Address - Street 2:SUITE 279
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3618
Practice Address - Country:US
Practice Address - Phone:239-343-9710
Practice Address - Fax:239-343-9715
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007521207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252931900Medicaid
FL57572ZMedicare PIN
FL57572Medicare ID - Type Unspecified
FL252931900Medicaid
FLG60285Medicare UPIN