Provider Demographics
NPI:1902062649
Name:FERNANDEZ DE CASTRO, JUAN PABLO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:PABLO
Last Name:FERNANDEZ DE CASTRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:44 BARKLEY CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7530
Mailing Address - Country:US
Mailing Address - Phone:239-985-7171
Mailing Address - Fax:239-985-7118
Practice Address - Street 1:2550 S DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6104
Practice Address - Country:US
Practice Address - Phone:239-985-7171
Practice Address - Fax:239-985-7118
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME130787207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program