Healthcare Provider Details

I. General information

NPI: 1093829103
Provider Name (Legal Business Name): ALFREDO FERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 10/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 WEBB RD SUITE # 101
TAMPA FL
33615-2872
US

IV. Provider business mailing address

6101 WEBB RD SUITE # 101
TAMPA FL
33615-2872
US

V. Phone/Fax

Practice location:
  • Phone: 813-496-9663
  • Fax: 813-496-9921
Mailing address:
  • Phone: 813-496-9663
  • Fax: 813-496-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME44443
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME44443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: