Provider Demographics
NPI:1902662315
Name:FERMIN, JESUS ALBERTO (RDMS)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:ALBERTO
Last Name:FERMIN
Suffix:
Gender:M
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 WILLOW BECK LN APT 303
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5121
Mailing Address - Country:US
Mailing Address - Phone:786-587-4752
Mailing Address - Fax:
Practice Address - Street 1:6210 WILLOW BECK LN APT 303
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-5121
Practice Address - Country:US
Practice Address - Phone:786-587-4752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2732802085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound