MEDICARE: FERNANDO A CARBALLO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	53132	MN
2	207RG0100X	Gastroenterology Physician	ME137751	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00742968	OTHER	WI	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427010362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO A CARBALLO M.D.

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	8380 RIVERWALK PARK BLVD STE 310
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-8758
Country	:	US
Telephone Number	:	239-291-3602
Fax Number	:	239-291-3603

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	10/30/2023

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Directions to “ FERNANDO A CARBALLO M.D.” Practice Location

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