Provider Demographics
NPI:1043320021
Name:IGLECIA - FERNANDEZ, RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:IGLECIA - FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 HOOKS ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3514
Mailing Address - Country:US
Mailing Address - Phone:352-394-0833
Mailing Address - Fax:352-394-0367
Practice Address - Street 1:2440 HOOKS ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3514
Practice Address - Country:US
Practice Address - Phone:352-394-0833
Practice Address - Fax:523-394-0367
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010300602084P0800X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI150343300OtherUS DEPT OF LABOR
VAC10333OtherMEDICARE
VA1043320021OtherNPI
NC890627XMedicaid
VAO86851OtherSENTARA
VAO86851OtherSENTARA
VAO86851OtherSENTARA
VAB60113Medicare UPIN
VA0077117400Medicaid