Healthcare Provider Details

I. General information

NPI: 1114595956
Provider Name (Legal Business Name): FERNANDO MORENO MATEO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date: 03/27/2023
Reactivation Date: 03/03/2025

III. Provider practice location address

8331 N DAVIS HWY. 8331 N DAVIS HWY.
PENSACOLA FL
32514
US

IV. Provider business mailing address

8331 N DAVIS HWY. NEMOURS
PENSACOLA FL
32514
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-4700
  • Fax:
Mailing address:
  • Phone: 850-505-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number170992
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number170992
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number170992
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number170992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: