MEDICARE: DR. JORGE ENRIQUE FERNANDEZ 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	208D00000X	General Practice Physician	ACN - 752	FL
2	208D00000X	General Practice Physician	ME163130	FL
3	208D00000X	General Practice Physician	020989	PR

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	:	1649557059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE ENRIQUE FERNANDEZ MD

Provider Business Mailing Address
First Line	:	16325 NW 78TH AVE
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-8410
Country	:	US
Telephone Number	:	786-218-0068
Fax Number	:

Provider Business Practice Location Address
First Line	:	11420 N KENDALL DR STE 110
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-1039
Country	:	US
Telephone Number	:	786-353-2536
Fax Number	:

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

Provider Enumeration Date	:	11/14/2011
Last Update Date	:	01/23/2024

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Directions to “ DR. JORGE ENRIQUE FERNANDEZ MD” Practice Location

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