Provider Demographics
NPI:1669667879
Name:SAUNDERS, IRA S (PA-C)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:S
Last Name:SAUNDERS
Suffix:
Gender:M
Credentials:PA-C
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 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-1105
Mailing Address - Fax:239-343-1106
Practice Address - Street 1:13782 PLANTATION RD
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4462
Practice Address - Country:US
Practice Address - Phone:239-343-1105
Practice Address - Fax:239-343-1106
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104199363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016780600Medicaid
FLPA9104199OtherLICENSE