MEDICARE: ALFREDO M FERNANDEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME81416	FL

General Provider Information

NPI Number	:	1255320263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFREDO M FERNANDEZ MD

Provider Business Mailing Address
First Line	:	5984 W 14TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-6245
Country	:	US
Telephone Number	:	305-825-2052
Fax Number	:

Provider Business Practice Location Address
First Line	:	1546 W 49TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2923
Country	:	US
Telephone Number	:	305-821-3445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/08/2007

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