MEDICARE: DR. ELIO A FERNANDEZ MD

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	ME41476	FL

General Provider Information

NPI Number	:	1720073877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIO A FERNANDEZ MD

Provider Business Mailing Address
First Line	:	26607 N 59TH LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85083-6523
Country	:	US
Telephone Number	:	623-414-3484
Fax Number	:

Provider Business Practice Location Address
First Line	:	26607 N 59TH LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85083-6523
Country	:	US
Telephone Number	:	623-414-3484
Fax Number	:

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	11/17/2009

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