Provider Demographics
NPI:1639184492
Name:DEIORIO BEAULIEU & FULLER
Entity Type:Organization
Organization Name:DEIORIO BEAULIEU & FULLER
Other - Org Name:ORTHOPEDIC ASSOCIATES OF CAPE CORAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN.
Authorized Official - Prefix:MS
Authorized Official - First Name:LELA
Authorized Official - Middle Name:F
Authorized Official - Last Name:DERISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-772-7229
Mailing Address - Street 1:657 DEL PRADO BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2666
Mailing Address - Country:US
Mailing Address - Phone:239-772-4484
Mailing Address - Fax:239-772-2903
Practice Address - Street 1:657 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2666
Practice Address - Country:US
Practice Address - Phone:239-772-4484
Practice Address - Fax:239-772-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99716Medicare ID - Type Unspecified
FL0125570001Medicare NSC