Provider Demographics
NPI:1316983232
Name:FERNS, JUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:FERNS
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:PO BOX 1539
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-1539
Mailing Address - Country:US
Mailing Address - Phone:352-854-0681
Mailing Address - Fax:352-854-8031
Practice Address - Street 1:4730 SW 49TH RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-6262
Practice Address - Country:US
Practice Address - Phone:352-854-0681
Practice Address - Fax:352-854-8031
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85309207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17351OtherBCBS
FL060069803OtherRAILROAD MEDICARE
FL266851300Medicaid
FL17351VMedicare PIN
FL060069803OtherRAILROAD MEDICARE
FLH33440Medicare UPIN