Healthcare Provider Details

I. General information

NPI: 1124433644
Provider Name (Legal Business Name): FERNANDO WOLL PLENGE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10299 SOUTHERN BLVD # 212773
ROYAL PALM BEACH FL
33411-4337
US

IV. Provider business mailing address

10299 SOUTHERN BLVD # 212773
ROYAL PALM BEACH FL
33411-4337
US

V. Phone/Fax

Practice location:
  • Phone: 305-735-2452
  • Fax: 561-584-5551
Mailing address:
  • Phone: 305-735-2452
  • Fax: 561-584-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberU7962
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number53473
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberU7962
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: