Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 147713 | FL |
NPI | 1225424716 |
---|---|
Provider Name | Dr. Elizabeth Mccutcheon Casey Guadagni |
First Address | Fort Myers, FL 33919-5193 |
Second Address | Fort Myers, FL 33919-5193 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2015 |
Last Update Date | 19/05/2021 |