Provider Demographics
NPI:1790925311
Name:SOARES, FERNANDO AUGUSTO (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:AUGUSTO
Last Name:SOARES
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 1:10562 OAKLEY TRACE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3320
Mailing Address - Country:US
Mailing Address - Phone:956-793-2981
Mailing Address - Fax:
Practice Address - Street 1:8585 PICARDY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3748
Practice Address - Country:US
Practice Address - Phone:225-397-1812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-22
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD74062080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6632230Medicaid
SDS104368Medicare PIN
SDS103430Medicare PIN