1578925558 NPI number — DR. LUIS MIGUEL CALVO FRAGACHAN M.D.

Table of content: DR. LUIS MIGUEL CALVO FRAGACHAN M.D. (NPI 1578925558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578925558 NPI number — DR. LUIS MIGUEL CALVO FRAGACHAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALVO FRAGACHAN
Provider First Name:
LUIS
Provider Middle Name:
MIGUEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALVO
Provider Other First Name:
LUIS
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1578925558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38135 MARKET SQUARE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZEPHYRHILLS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33542-7505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-567-0188
Provider Business Mailing Address Fax Number:
813-355-5101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36763 EILAND BLVD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZEPHYRHILLS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33542-0600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-778-0454
Provider Business Practice Location Address Fax Number:
813-377-1699
Provider Enumeration Date:
03/28/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0101267924 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: ME142788 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 121356000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".