MEDICARE: FERNANDEZ BLAY MD PA

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	207R00000X	Internal Medicine Physician	ME93447	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306898242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERNANDEZ BLAY MD PA

Provider Business Mailing Address
First Line	:	14143 SW 52ND ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-5978
Country	:	US
Telephone Number	:	305-322-8096
Fax Number	:

Provider Business Practice Location Address
First Line	:	2488 N UNIVERSITY DR
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-3624
Country	:	US
Telephone Number	:	954-983-9191
Fax Number	:	305-829-1401

Authorized Official
Title or Position	:	PRES/OWNER
Name	:	ROBERTO CARLOS FERNANDEZ BLAY
Credential	:	MD
Telephone Number	:	305-322-8096

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	10/27/2008

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