Provider Demographics
NPI:1780796359
Name:YARRIS-EWERT, LINDA MARIAN (PHD, MD, PA)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MARIAN
Last Name:YARRIS-EWERT
Suffix:
Gender:F
Credentials:PHD, MD, PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12545 NEW BRITTANY BLVD
Mailing Address - Street 2:SUITE 26
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3625
Mailing Address - Country:US
Mailing Address - Phone:239-274-2071
Mailing Address - Fax:239-274-2075
Practice Address - Street 1:12545 NEW BRITTANY BLVD
Practice Address - Street 2:SUITE 26
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3625
Practice Address - Country:US
Practice Address - Phone:239-274-2071
Practice Address - Fax:239-274-2075
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0064852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAS19990440001OtherCIGNA INSURANCE
FL194736OtherSTAYWELL HEALTHY KIDS
FL23801OtherBLUE CROSS BLUE SHIELD
FL2666792OtherAETNA HEALTHCARE
FL374409400Medicaid
FL65-1147398OtherTAX ID NUMBER
FLF74038Medicare UPIN
FLAS19990440001OtherCIGNA INSURANCE
FL65-1147398OtherTAX ID NUMBER