1679540744 NPI number — DR. LAURENCE R FERBER M.D.

Table of content: DR. LAURENCE R FERBER M.D. (NPI 1679540744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679540744 NPI number — DR. LAURENCE R FERBER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERBER
Provider First Name:
LAURENCE
Provider Middle Name:
R
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679540744
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 W HIGHLAND BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INVERNESS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34452-4717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-726-3646
Provider Business Mailing Address Fax Number:
352-726-0079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7062 S ALOYSIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORAL CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34436-2844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-364-4038
Provider Business Practice Location Address Fax Number:
352-419-4302
Provider Enumeration Date:
03/07/2006

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: 2086S0127X , with the licence number:  ME85110 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: ME85110 , 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: 258062400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 266503400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 78746 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00006849 . This is a "RR MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 014569300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com