Provider Demographics
NPI:1720218530
Name:QUEVEDO, KARLA (MD)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:QUEVEDO
Suffix:
Gender:F
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-6350
Mailing Address - Fax:239-343-6358
Practice Address - Street 1:9800 S HEALTH PARK DR
Practice Address - Street 2:SUITE 320
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3630
Practice Address - Country:US
Practice Address - Phone:239-343-6350
Practice Address - Fax:239-343-6358
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122595207RC0000X, 207R00000X
TXBP10034692207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015146100Medicaid