Healthcare Provider Details

I. General information

NPI: 1174533434
Provider Name (Legal Business Name): JOSE R FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SW 87TH AVENUE SUITE C350
MIAMI FL
33173
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 400
MIAMI FL
33126-2051
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-4711
  • Fax: 305-271-8732
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME66013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: