Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME44443 | FL |
Y | 208600000X | Surgeon | ME44443 | FL |
N | 2086S0122X | Plastic and Reconstructive Surgery | ME44443 | FL |
NPI | 1093829103 |
---|---|
Provider Name | Dr. Alfredo Fernandez |
First Address | Tampa, FL 33615-2872 |
Second Address | Tampa, FL 33615-2872 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 02/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043586400 | (05) | FL |
30920 | BCBS (01) | FL |
D65367 | (02) |