MEDICARE: DR. GABRIEL I 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	207Q00000X	Family Medicine Physician	9901528	NC

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	:	1902808850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIEL I FERNANDEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 87945
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-7945
Country	:	US
Telephone Number	:	910-867-7777
Fax Number	:	910-868-7778

Provider Business Practice Location Address
First Line	:	530 SANDHURST DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-4426
Country	:	US
Telephone Number	:	910-867-7777
Fax Number	:	910-868-7778

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	12/01/2014

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