MEDICARE: FERNANDO MIGUEL FERNANDEZ D.O.

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	207VG0400X	Gynecology Physician	OS7630	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1023079670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO MIGUEL FERNANDEZ D.O.

Provider Business Mailing Address
First Line	:	PO BOX 16568
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32245-6568
Country	:	US
Telephone Number	:	904-472-2300
Fax Number	:	904-472-2330

Provider Business Practice Location Address
First Line	:	14540 OLD SAINT AUGUSTINE RD STE 2391
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258
Country	:	US
Telephone Number	:	904-268-5300
Fax Number	:	904-268-5040

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	05/31/2018

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Directions to “ FERNANDO MIGUEL FERNANDEZ D.O.” Practice Location

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