Healthcare Provider Details

I. General information

NPI: 1710178280
Provider Name (Legal Business Name): FERDINAND LOUIS RIOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 ARCOS AVE STE 207
ESTERO FL
33928-9461
US

IV. Provider business mailing address

1233 SEA BREEZE CT
PUNTA GORDA FL
33950-7637
US

V. Phone/Fax

Practice location:
  • Phone: 239-301-0968
  • Fax: 941-205-2181
Mailing address:
  • Phone: 941-875-8637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME102997
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME102997
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License NumberME102997F
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: