Healthcare Provider Details

I. General information

NPI: 1568686707
Provider Name (Legal Business Name): ALFREDO D FERNANDEZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 S TAMIAMI TRL
SARASOTA FL
34239-3841
US

IV. Provider business mailing address

2426 S TAMIAMI TRL
SARASOTA FL
34239-3841
US

V. Phone/Fax

Practice location:
  • Phone: 941-906-7546
  • Fax:
Mailing address:
  • Phone: 941-906-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALFREDO D FERNANDEZ
Title or Position: OWNER
Credential: MD
Phone: 941-906-7546