MEDICARE: ROBERTO C FERNANDEZ BLAY MD

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	207R00000X	Internal Medicine Physician	ME93447	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205821352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTO C FERNANDEZ BLAY MD

Provider Business Mailing Address
First Line	:	9999 SHERIDAN ST STE 120
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-3086
Country	:	US
Telephone Number	:	954-983-9191
Fax Number	:	954-449-7651

Provider Business Practice Location Address
First Line	:	9999 SHERIDAN ST STE 120
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-3086
Country	:	US
Telephone Number	:	954-890-2524
Fax Number	:	954-890-2523

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	12/13/2022

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