Provider Demographics
NPI:1710984687
Name:ECHAVARRIA, FABIO LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:FABIO
Middle Name:LEON
Last Name:ECHAVARRIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 121373
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-1373
Mailing Address - Country:US
Mailing Address - Phone:352-243-7495
Mailing Address - Fax:352-243-7498
Practice Address - Street 1:1715 E HWY 50
Practice Address - Street 2:BUILDING 3, SUITE C
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5187
Practice Address - Country:US
Practice Address - Phone:352-243-7495
Practice Address - Fax:352-243-7498
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0077560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110237691OtherMEDICARE RAILROAD
FL257964200Medicaid
FL257964200Medicaid
FL110237691OtherMEDICARE RAILROAD