Provider Demographics
NPI:1093736738
Name:FERNANDEZ-LANG, JULIE M (DO)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:FERNANDEZ-LANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:M
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:421 WOODBURY PINES CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9089
Mailing Address - Country:US
Mailing Address - Phone:321-663-3601
Mailing Address - Fax:
Practice Address - Street 1:5469 SW 34TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-5032
Practice Address - Country:US
Practice Address - Phone:352-548-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL752989582OtherTIN
FL28019Medicare ID - Type Unspecified
FLH69604Medicare UPIN