Provider Demographics
NPI:1821069030
Name:ANCAYA-LUJAN, DORA V (MD)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:V
Last Name:ANCAYA-LUJAN
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:6120 WINKLER RD STE E
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8191
Practice Address - Country:US
Practice Address - Phone:239-481-2400
Practice Address - Fax:239-481-2662
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109680208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003825700Medicaid
FL9524087.OtherAETNA
FLP00969463OtherRR MEDICARE
FL14F03OtherBCBSFL
FLAQ117ZOtherMEDICARE PTAN
FL3458947OtherCIGNA