# DR. FANOURIOS IACOVOS FERDERIGOS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1235120122
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | ME40703 | FL | Yes |

## Other

- **Enumeration date:** 10/31/2005
- **Last updated:** 06/12/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 02051 | WELLCARE PROVIDER NUMBER | FL |
| 01 | — | 10015687 | RAILROAD MEDICARE | FL |
| 01 | — | 1573201020 | CIGNA PROVIDER NUMBER | FL |
| 01 | — | 15800Z | MEDICARE PTAN | FL |
| 01 | — | 207845 | AVMED PROVIDER NUMBER | FL |
| 01 | — | 220139000 | FEDERAL WORKERS COMP PROV | FL |
| 01 | — | 4133544 | AETNA PPO | FL |
| 01 | — | 592745575001 | CHAMPUS PROVIDER NUMBER | FL |
| 01 | — | 624281 | AETNA HMO | FL |