Healthcare Provider Details

I. General information

NPI: 1740330711
Provider Name (Legal Business Name): FERMIN LEGUEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 S DECATUR BLVD
LAS VEGAS NV
89107
US

IV. Provider business mailing address

7551 FOREST OAKS BLVD
SPRING HILL FL
34606
US

V. Phone/Fax

Practice location:
  • Phone: 702-759-1000
  • Fax: 702-759-1478
Mailing address:
  • Phone: 352-540-6800
  • Fax: 352-688-5030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME79753
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME79753
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: