Provider Demographics
NPI:1053557124
Name:LINDA YARRIS-EWERT PHD MD PA
Entity type:Organization
Organization Name:LINDA YARRIS-EWERT PHD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIAN
Authorized Official - Last Name:YARRIS-EWERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:239-274-2071
Mailing Address - Street 1:12545 NEW BRITTANY BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3625
Mailing Address - Country:US
Mailing Address - Phone:239-274-2071
Mailing Address - Fax:
Practice Address - Street 1:12545 NEW BRITTANY BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3625
Practice Address - Country:US
Practice Address - Phone:239-274-2071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-19
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0064852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374409400OtherMEDICAID
FLAS19990440001OtherCIGNA INSURANCE
FL194736OtherSTAYWELL HEALTHY KIDS
FL23801OtherBLUE CROSS BLUE SHIELD
FL2666792OtherAETNA HEALTHCARE
FLF74038Medicare UPIN
FLAS19990440001OtherCIGNA INSURANCE