Blackwell, Lea Moreen
Blackwell, Lea Moreen is an individual health care provider with primary practice located at 13691 Metro Pkwy Ste 300 , Fort Myers FL 33912-4322. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery is her primary health care specialty. Blackwell, Lea Moreen can be contacted via phone (239) 264-1236.Contact Information
Primary practice address
13691 Metro Pkwy Ste 300
Fort Myers FL 33912-4322
Phone: (239) 264-1236
Fax: (321) 359-7055
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
Allopathic & Osteopathic Physicians / Surgery | 208600000X | ME102649 | Florida |
Profile Details
NPI number | 1356508410 |
---|---|
LBN Legal business name | Blackwell, Lea Moreen |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | May 16th, 2008 |
Last updated | Jun 27th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1356508410 | NPPES |
Florida | MEDICAID | 000373700 | |
Florida | Other | 0172805 | |
Florida | Other | P00657339 | |
Florida | Other | 463262 |
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