Provider Demographics
NPI:1356587125
Name:SOUZA, FREDERICO DE (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICO
Middle Name:DE
Last Name:SOUZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FREDERICO
Other - Middle Name:FERREIRA
Other - Last Name:SOUZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 919336
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:800-841-4236
Mailing Address - Fax:706-653-1230
Practice Address - Street 1:8900 N KENDALL DR DEPT OF
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2118
Practice Address - Country:US
Practice Address - Phone:786-596-2314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227694174400000X
MS211002085R0202X
FLME1323322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL156805Medicaid
MS302I309420Medicare PIN
MS302I305436Medicare PIN