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NPI Code Detail

MEDICARE: RAYMOND FERNANDEZ M.D.

MEDICARE: RAYMOND 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
12084N0402XNeurology with Special Qualifications in Child Neurology PhysicianME14404FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
229947XOTHERFLMEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number : 1508895905
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAYMOND FERNANDEZ M.D.
Provider Business Mailing Address
First Line : 1033 DR MARTIN LUTHER KING JR ST N
Second Line : SUITE 108
City : ST PETERSBURG
State : FL
Zip : 33701-1547
Country : US
Telephone Number : 727-456-4250
Fax Number : 727-346-1044
Provider Business Practice Location Address
First Line : 2508 W VIRGINIA AVE
Second Line : SUITE B
City : TAMPA
State : FL
Zip : 33607-6326
Country : US
Telephone Number : 813-878-2191
Fax Number : 813-872-2659
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 02/03/2010

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Directions to “ RAYMOND FERNANDEZ M.D.” Practice Location

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