MEDICARE: FELIX L FERNANDEZ D.O.

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	OS8556	FL
2	207Q00000X	Family Medicine Physician	2692	TN

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
2	6023306	OTHER	TN	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629017397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELIX L FERNANDEZ D.O.

Provider Business Mailing Address
First Line	:	PO BOX 632476
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-2476
Country	:	US
Telephone Number	:	423-636-2700
Fax Number	:	423-232-8573

Provider Business Practice Location Address
First Line	:	1021 COOLIDGE ST STE 2
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37743-4672
Country	:	US
Telephone Number	:	423-636-2700
Fax Number	:	423-232-8573

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	02/18/2025

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