Provider Demographics
NPI:1235110057
Name:FERNANDEZ, RICHARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9210 SW 72ND ST
Mailing Address - Street 2:STE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3274
Mailing Address - Country:US
Mailing Address - Phone:305-595-6202
Mailing Address - Fax:305-595-6201
Practice Address - Street 1:9210 SW 72ND ST
Practice Address - Street 2:STE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3274
Practice Address - Country:US
Practice Address - Phone:305-595-6202
Practice Address - Fax:305-595-6201
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0053192207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51860Medicare UPIN
FL07127MMedicare PIN