Provider Demographics
NPI:1598701302
Name:FERMO, REYNALDO G JR (MD)
Entity Type:Individual
Prefix:
First Name:REYNALDO
Middle Name:G
Last Name:FERMO
Suffix:JR
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 1:7855 ARGYLE FOREST BLVD
Mailing Address - Street 2:STE 804
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244
Mailing Address - Country:US
Mailing Address - Phone:904-779-5870
Mailing Address - Fax:904-779-5871
Practice Address - Street 1:7855 ARGYLE FOREST BLVD
Practice Address - Street 2:STE 804
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244
Practice Address - Country:US
Practice Address - Phone:904-779-5870
Practice Address - Fax:904-779-5871
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37304OtherBLUE CROSS
FL5347089OtherAETNA
FL268496900Medicaid
FL37304Medicare ID - Type Unspecified
FL268496900Medicaid