Healthcare Provider Details

I. General information

NPI: 1295900819
Provider Name (Legal Business Name): JOSE MANUEL FERNANDEZ-SEMIDEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12470 TELECOM DR SUITE 300W
TEMPLE TERRACE FL
33637-0904
US

IV. Provider business mailing address

12470 TELECOM DR SUITE 300W
TEMPLE TERRACE FL
33637-0904
US

V. Phone/Fax

Practice location:
  • Phone: 863-287-6569
  • Fax: 863-968-1797
Mailing address:
  • Phone: 863-287-6569
  • Fax: 863-968-1797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME105393
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: