Provider Demographics
NPI:1811290190
Name:J FRANK AVEY PA
Entity type:Organization
Organization Name:J FRANK AVEY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:AVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-368-2839
Mailing Address - Street 1:260 BETH STACEY BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936
Mailing Address - Country:US
Mailing Address - Phone:239-368-2839
Mailing Address - Fax:239-368-5011
Practice Address - Street 1:260 BETH STACEY BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936
Practice Address - Country:US
Practice Address - Phone:239-368-2839
Practice Address - Fax:239-368-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL66976207Q00000X
FLME66976207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF90411Medicare UPIN