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NPI Code Detail

MEDICARE: DR. FREDERICO YAMBAO FERNANDEZ M.D.

MEDICARE: DR. FREDERICO YAMBAO 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
1207R00000XInternal Medicine Physician21001AL

General Provider Information

NPI Number : 1972594505
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FREDERICO YAMBAO FERNANDEZ M.D.
Provider Business Mailing Address
First Line : 2804 GREENHILL BLVD NW
Second Line : SUITE 101
City : FORT PAYNE
State : AL
Zip : 35968-3066
Country : US
Telephone Number : 256-845-0023
Fax Number : 256-845-0238
Provider Business Practice Location Address
First Line : 2804 GREENHILL BLVD NW
Second Line : SUITE 101
City : FORT PAYNE
State : AL
Zip : 35968-3066
Country : US
Telephone Number : 256-845-0023
Fax Number : 256-845-0238
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 11/09/2009

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