Healthcare Provider Details

I. General information

NPI: 1609237932
Provider Name (Legal Business Name): WILBER M FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8429 CAMDEN ST APT A
TAMPA FL
33614-1967
US

IV. Provider business mailing address

8429 CAMDEN ST APT A
TAMPA FL
33614-1967
US

V. Phone/Fax

Practice location:
  • Phone: 813-743-8182
  • Fax:
Mailing address:
  • Phone: 813-743-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number16-157
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: