Provider Demographics
NPI:1871020669
Name:FORT MYERS MEDICAL UNIVERSER
Entity Type:Organization
Organization Name:FORT MYERS MEDICAL UNIVERSER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:XIOMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-244-4331
Mailing Address - Street 1:4351 DELEON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901
Mailing Address - Country:US
Mailing Address - Phone:239-244-4331
Mailing Address - Fax:
Practice Address - Street 1:4531 DELEON ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1278
Practice Address - Country:US
Practice Address - Phone:239-244-4331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty