Provider Demographics
NPI:1932174661
Name:CARDWELL, BRET A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRET
Middle Name:A
Last Name:CARDWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15730 NEW HAMPSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4121
Mailing Address - Country:US
Mailing Address - Phone:239-481-0033
Mailing Address - Fax:321-966-8322
Practice Address - Street 1:15730 NEW HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4121
Practice Address - Country:US
Practice Address - Phone:239-481-0033
Practice Address - Fax:321-966-8322
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162982208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118962900Medicaid