Provider Demographics
NPI:1295159952
Name:LISTENING DOCTOR PLLC
Entity type:Organization
Organization Name:LISTENING DOCTOR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-985-2600
Mailing Address - Street 1:13421 PARKER COMMONS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-2076
Mailing Address - Country:US
Mailing Address - Phone:239-985-2600
Mailing Address - Fax:239-985-0103
Practice Address - Street 1:13421 PARKER COMMONS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-2076
Practice Address - Country:US
Practice Address - Phone:239-985-2600
Practice Address - Fax:239-985-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-14
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10628400Medicaid
HS798AMedicare PIN