MEDICARE: ROBERT C. 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	2084P0800X	Psychiatry Physician	ME0015855	FL

General Provider Information

NPI Number	:	1558410522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT C. FERNANDEZ M.D.

Provider Business Mailing Address
First Line	:	4890 W KENNEDY BLVD
Second Line	:	SUITE 990
City	:	TAMPA
State	:	FL
Zip	:	33609-1851
Country	:	US
Telephone Number	:	813-288-1564
Fax Number	:	813-288-7317

Provider Business Practice Location Address
First Line	:	4890 W KENNEDY BLVD
Second Line	:	SUITE 990
City	:	TAMPA
State	:	FL
Zip	:	33609-1851
Country	:	US
Telephone Number	:	813-288-1564
Fax Number	:	813-288-7317

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/09/2007

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