Provider Demographics
NPI:1801000161
Name:FORMOSO, FERDINAND JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:FERDINAND
Middle Name:JOSEPH
Last Name:FORMOSO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11555 CENTRAL PKWY STE 304
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-2694
Mailing Address - Country:US
Mailing Address - Phone:904-201-3111
Mailing Address - Fax:904-201-3095
Practice Address - Street 1:11555 CENTRAL PKWY
Practice Address - Street 2:SUITE 304
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2691
Practice Address - Country:US
Practice Address - Phone:904-265-7755
Practice Address - Fax:904-265-7754
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10067208VP0014X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00656925OtherMEDICARE RAILROAD
FL000307800Medicaid
FL52892OtherBCBS
FLP00656925OtherMEDICARE RAILROAD