Provider Demographics
NPI:1457397853
Name:FUENTES, FRANK M (MD, PA)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:M
Last Name:FUENTES
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:FRANCISCO
Other - Middle Name:M
Other - Last Name:FUENTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:306 ARTHUR GODFREY RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3603
Mailing Address - Country:US
Mailing Address - Phone:305-673-5100
Mailing Address - Fax:305-673-9106
Practice Address - Street 1:306 ARTHUR GODFREY RD
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3603
Practice Address - Country:US
Practice Address - Phone:305-673-5100
Practice Address - Fax:305-673-9106
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047607201Medicaid
FL96257Medicare PIN
FL047607201Medicaid