Healthcare Provider Details

I. General information

NPI: 1437160322
Provider Name (Legal Business Name): FERNANDO OMAR ABAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 OAK ST
MELBOURNE FL
32901-3111
US

IV. Provider business mailing address

2855 OLD HIGHWAY 5 STE 101
BLUE RIDGE GA
30513-6239
US

V. Phone/Fax

Practice location:
  • Phone: 321-723-4723
  • Fax: 321-727-1448
Mailing address:
  • Phone:
  • Fax: 321-727-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number57848
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME56659
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: