Provider Demographics
NPI:1558397356
Name:BRANCO, FERNANDO S (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:S
Last Name:BRANCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 NE 2ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137
Mailing Address - Country:US
Mailing Address - Phone:305-532-7246
Mailing Address - Fax:305-534-3974
Practice Address - Street 1:5200 NE 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137
Practice Address - Country:US
Practice Address - Phone:305-532-7246
Practice Address - Fax:305-534-3974
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88115208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2674998-00Medicaid
FL71378YMedicare PIN
FL71378YMedicare Oscar/Certification
FL71378XMedicare PIN
FLH97400Medicare UPIN