Healthcare Provider Details

I. General information

NPI: 1710015284
Provider Name (Legal Business Name): FREDDIE JOSE NEGRON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 TAMIAMI TRL N STE 102
NAPLES FL
34103-2849
US

IV. Provider business mailing address

5190 GENOA ST
AVE MARIA FL
34142-5091
US

V. Phone/Fax

Practice location:
  • Phone: 239-649-2300
  • Fax:
Mailing address:
  • Phone: 305-479-1483
  • Fax: 305-690-4881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME67488
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME67488
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME67488
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: