Healthcare Provider Details

I. General information

NPI: 1639396187
Provider Name (Legal Business Name): DENNIS L FERNANDEZ MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 PEPPERWOOD CIR SW SUITE C
HUNTSVILLE AL
35801-7433
US

IV. Provider business mailing address

4025 PEPPERWOOD CIR SW SUITE C
HUNTSVILLE AL
35801-7433
US

V. Phone/Fax

Practice location:
  • Phone: 256-882-1908
  • Fax: 256-882-1907
Mailing address:
  • Phone: 256-882-1908
  • Fax: 256-882-1907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25395
License Number StateAL

VIII. Authorized Official

Name: DR. DENNIS L FERNANDEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 256-882-1908