Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | OS7630 | FL |
NPI | 1023079670 |
---|---|
Provider Name | Fernando Miguel Fernandez |
First Address | Jacksonville, FL 32245-6568 |
Second Address | Jacksonville, FL 32258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 31/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
254722800 | (05) | FL |
G76926 | (02) | FL |