Provider Demographics
NPI:1346556248
Name:REYNALDO G FERMO MD PA
Entity Type:Organization
Organization Name:REYNALDO G FERMO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REYNALOD
Authorized Official - Middle Name:F
Authorized Official - Last Name:FERMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-421-2119
Mailing Address - Street 1:7855 ARGYLE FOREST BLVD
Mailing Address - Street 2:# 804
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5596
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7855 ARGYLE FOREST BLVD
Practice Address - Street 2:# 804
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5596
Practice Address - Country:US
Practice Address - Phone:904-421-2119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty