Provider Demographics
NPI:1619043700
Name:FOO, MAY LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:MAY
Middle Name:LYNNE
Last Name:FOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:7341 GLADIOLUS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-5101
Practice Address - Country:US
Practice Address - Phone:239-489-3420
Practice Address - Fax:239-489-3219
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00618862085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113394OtherOPERATING ENG. PROVIDER #
FL317489OtherAMERIGROUP PROVIDER #
FL5291079OtherAETNA PROVIDER #
FL277312100Medicaid
FL3704799OtherCIGNA PROVIDER #
FLE16325Medicare UPIN
FL277312100Medicaid