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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