Basic Information
| Provider Information | |||||||||
| NPI: | 1053557124 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LINDA YARRIS-EWERT PHD MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12545 NEW BRITTANY BLVD | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339073625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392742071 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12545 NEW BRITTANY BLVD | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339073625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392742071 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2008 | ||||||||
| LastUpdateDate: | 01/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | YARRIS-EWERT | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | MARIAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2392742071 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD, MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0064852 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 374409400 | 01 | FL | MEDICAID | OTHER | AS19990440001 | 01 | FL | CIGNA INSURANCE | OTHER | 194736 | 01 | FL | STAYWELL HEALTHY KIDS | OTHER | 23801 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 2666792 | 01 | FL | AETNA HEALTHCARE | OTHER |