Provider Demographics
NPI:1992722607
Name:FAGEL-FACTORA, BEATRICE L (MD)
Entity type:Individual
Prefix:DR
First Name:BEATRICE
Middle Name:L
Last Name:FAGEL-FACTORA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18070 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 8
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4602
Mailing Address - Country:US
Mailing Address - Phone:239-267-3031
Mailing Address - Fax:239-267-2434
Practice Address - Street 1:18070 S TAMIAMI TRL
Practice Address - Street 2:SUITE 8
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4602
Practice Address - Country:US
Practice Address - Phone:239-267-3031
Practice Address - Fax:239-267-2434
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62961208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25338Medicare ID - Type Unspecified
FLF81735Medicare UPIN