MEDICARE: DR. RONALD CHARLES FERNANDEZ M.D.

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	ME 32701	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	593629890	OTHER	TRICARE
2	55096	OTHER	BCBS
3	593629890	OTHER	HUMANA
4	0622399	OTHER	AETNA

General Provider Information

NPI Number	:	1255381224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD CHARLES FERNANDEZ M.D.

Provider Business Mailing Address
First Line	:	31922 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3730
Country	:	US
Telephone Number	:	727-787-7520
Fax Number	:	727-789-0653

Provider Business Practice Location Address
First Line	:	31922 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3730
Country	:	US
Telephone Number	:	727-787-7520
Fax Number	:	727-789-0653

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	11/12/2007

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Directions to “ DR. RONALD CHARLES FERNANDEZ M.D.” Practice Location

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