Provider Demographics
NPI:1639114820
Name:VALLE, FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:VALLE
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 1:255 CITRUS TOWER BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2756
Mailing Address - Country:US
Mailing Address - Phone:352-536-6340
Mailing Address - Fax:352-536-1673
Practice Address - Street 1:255 CITRUS TOWER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2756
Practice Address - Country:US
Practice Address - Phone:352-536-6340
Practice Address - Fax:352-536-1673
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41752207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E75797Medicare UPIN