Provider Demographics
NPI:1609960954
Name:EAR NOSE & THROAT ASSOCIATES MD PA
Entity Type:Organization
Organization Name:EAR NOSE & THROAT ASSOCIATES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DRUMMOND
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-939-2621
Mailing Address - Street 1:9711 COMMERCE CENTER CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3817
Mailing Address - Country:US
Mailing Address - Phone:239-939-2621
Mailing Address - Fax:239-939-3875
Practice Address - Street 1:9711 COMMERCE CENTER CT
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3817
Practice Address - Country:US
Practice Address - Phone:239-939-2621
Practice Address - Fax:239-939-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268721600Medicaid
FL21549AMedicare ID - Type Unspecified