Individual
DR. FANOURIOS IACOVOS FERDERIGOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
ME40703
FL
Other
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
Enumeration date
10/31/2005
Last updated
06/12/2015
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