Provider Demographics
NPI:1497965206
Name:FERNANDEZ DE LEON, IRMA MAY AVILA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRMA MAY
Middle Name:AVILA
Last Name:FERNANDEZ DE LEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IRMA
Other - Middle Name:
Other - Last Name:F. DE LEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:333 WHITESPORT DR SW
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6454
Mailing Address - Country:US
Mailing Address - Phone:256-213-7425
Mailing Address - Fax:256-213-9950
Practice Address - Street 1:333 WHITESPORT DR SW
Practice Address - Street 2:SUITE 203
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6454
Practice Address - Country:US
Practice Address - Phone:256-213-7425
Practice Address - Fax:256-213-9950
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL18151OtherSTATE LICENSE NUMBER
AL515 14810Medicare ID - Type Unspecified
AL18151OtherSTATE LICENSE NUMBER