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Organization
FANOURIOS I. FERDERIGOS, M.D., P.A.
Active
Organization
FANOURIOS I. FERDERIGOS, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FANOURIOS I. FERDERIGOS M.D. (PRESIDENT)
(727) 789-3300
Entity
Organization
Contact information
Practice address
2626 TAMPA RD, SUITE 103, PALM HARBOR, FL 34684-3155
(727) 789-3300
(727) 787-3454
Mailing address
2626 TAMPA RD, SUITE 103, PALM HARBOR, FL 34684-3155
(727) 789-3300
(727) 787-3454
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME0040703
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
220139000
FEDERAL WORKERS COMP PROV
FL
01
—
GC512A
MEDICARE PTAN
FL
Enumeration date
11/02/2010
Last updated
06/26/2015
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