Provider Demographics
NPI:1437160322
Name:ABAD, FERNANDO OMAR (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:OMAR
Last Name:ABAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 OLD HIGHWAY 5
Mailing Address - Street 2:STE 101
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-6239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:321-727-1448
Practice Address - Street 1:1304 OAK ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3111
Practice Address - Country:US
Practice Address - Phone:321-723-4723
Practice Address - Fax:321-727-1448
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN57848207L00000X
FLME56659207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10276OtherBCBSFL
FL063843900Medicaid
FL050081536OtherRRMCR
FLE76162Medicare UPIN
FL10276OtherBCBSFL