=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376680744
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAYMOND N. FERNANDEZ, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2007
-----------------------------------------------------
Last Update Date | 10/15/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4198 US HIGHWAY 431 STE A
-----------------------------------------------------
City | ALBERTVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35950-0242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-891-8580
-----------------------------------------------------
Fax | 256-891-8581
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4198 US HIGHWAY 431 STE A
-----------------------------------------------------
City | ALBERTVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35950-0242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-891-8580
-----------------------------------------------------
Fax | 256-891-8581
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RAYMOND N FERNANDEZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 256-891-8580
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | MD.22283
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------