Provider Demographics
NPI:1184710501
Name:FUMERO, CARLOS ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ANTONIO
Last Name:FUMERO
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 1:5301 N HABANA AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-6890
Mailing Address - Country:US
Mailing Address - Phone:813-876-3636
Mailing Address - Fax:813-870-0077
Practice Address - Street 1:205 N PLANT AVE
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4731
Practice Address - Country:US
Practice Address - Phone:813-876-3636
Practice Address - Fax:813-870-0077
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 94508207R00000X
FLME94508207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFN961ZMedicare PIN