Organization Name: | ROYAL PALM PHYSICIAN GROUP, PA |
NPI Number: | 1912368556 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KELLY A FONTANA (PRESIDENT) |
Mailing Address: | 1585 Pine Ridge Rd Ste 2 Naples |
State: | FL US |
Postal Code: | 341092105 |
Phone Number: | 2394513143 |
Fax Number: | 2394513145 |
NPI Enumeration Date: | 03/10/2016 |
NPI Last Update Date: | 03/10/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ME98117 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |