Provider Demographics
NPI:1982631784
Name:POIRIER, JOHN MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:POIRIER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 07283
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-0261
Mailing Address - Country:US
Mailing Address - Phone:239-332-4293
Mailing Address - Fax:239-332-4297
Practice Address - Street 1:1364 ALCAZAR AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-6617
Practice Address - Country:US
Practice Address - Phone:239-332-4293
Practice Address - Fax:239-332-4297
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0005547103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650857676OtherPSYCHOLOGIST
FLR74622Medicare UPIN
FL54082Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST