Provider Demographics
NPI:1275521510
Name:FERNANDEZ, DENNIS LAYSON (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LAYSON
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 PEPPERWOOD CIR SW
Mailing Address - Street 2:SUITE C
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-7433
Mailing Address - Country:US
Mailing Address - Phone:256-882-1908
Mailing Address - Fax:256-882-1907
Practice Address - Street 1:4025 PEPPERWOOD CIR SW
Practice Address - Street 2:SUITE C
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-7433
Practice Address - Country:US
Practice Address - Phone:256-882-1908
Practice Address - Fax:256-882-1907
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025395208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009935184Medicaid
AL1649439472Medicaid
AL051532507OtherBLUE CROSS BLUE SHIELD
AL051532507OtherBLUE CROSS BLUE SHIELD
AL1649439472Medicaid