Provider Demographics
NPI:1710178280
Name:RIOS, FERDINAND LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:FERDINAND
Middle Name:LOUIS
Last Name:RIOS
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 1:1233 SEA BREEZE CT
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-7637
Mailing Address - Country:US
Mailing Address - Phone:941-875-8637
Mailing Address - Fax:
Practice Address - Street 1:324 CROSS ST STE 113
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-4828
Practice Address - Country:US
Practice Address - Phone:941-205-2180
Practice Address - Fax:941-205-2181
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102997F2083S0010X
FLME1029972081S0010X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48137Medicare UPIN