Provider Demographics
NPI:1295997971
Name:JOHN MICHAEL POIRIER PA
Entity type:Organization
Organization Name:JOHN MICHAEL POIRIER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:POIRIER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:239-332-4293
Mailing Address - Street 1:PO BOX 07283
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-0283
Mailing Address - Country:US
Mailing Address - Phone:239-332-4293
Mailing Address - Fax:239-332-4297
Practice Address - Street 1:1364 ALCAZAR AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-6617
Practice Address - Country:US
Practice Address - Phone:239-332-4293
Practice Address - Fax:239-332-4297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0005547103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54082Medicare PIN
FLR74622Medicare UPIN