Healthcare Provider Details

I. General information

NPI: 1457560294
Provider Name (Legal Business Name): PETER MARK FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 BEE RIDGE RD STE CA
SARASOTA FL
34233-1260
US

IV. Provider business mailing address

3920 BEE RIDGE RD BLDG C
SARASOTA FL
34233-1207
US

V. Phone/Fax

Practice location:
  • Phone: 941-867-7463
  • Fax: 941-870-3839
Mailing address:
  • Phone: 941-867-7463
  • Fax: 941-870-3839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME104715
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME104715
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: