Provider Demographics
NPI:1285684753
Name:FERNANDEZ-CONCEPCION, MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:FERNANDEZ-CONCEPCION
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 1:12600 PEMBROKE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2544
Mailing Address - Country:US
Mailing Address - Phone:954-620-0026
Mailing Address - Fax:954-620-0047
Practice Address - Street 1:1806 N FLAMINGO RD
Practice Address - Street 2:SUITE 440
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1026
Practice Address - Country:US
Practice Address - Phone:954-620-0025
Practice Address - Fax:954-620-0047
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85860208D00000X
FLME0085860207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH72000Medicare UPIN