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General NPI Number Information
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NPI Number | 1801148432
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Entity Type | Organization
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Legal Business Name | BRADENTON PLASTIC SURGERY, P. A.
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 1220 59TH ST W
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City | BRADENTON
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State | FL
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Zip | 34209-4154
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Country | US
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Telephone | 941-795-2088
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Fax | 941-792-5139
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Provider Business Mailing Address
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Address Line | 1220 59TH ST W
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City | BRADENTON
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State | FL
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Zip | 34209-4154
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Country | US
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Telephone | 941-795-2088
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Fax | 941-792-5139
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ENRIQUE J FERNANDEZ
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Credential | M. D.
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Telephone | 941-795-2088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME0047930
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License Number State | FL
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