Provider Demographics
NPI:1558367722
Name:FERNANDEZ, EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:FERNANDEZ
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:350 NW 84TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1817
Practice Address - Country:US
Practice Address - Phone:954-370-7555
Practice Address - Fax:954-370-7554
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00733782085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL843672OtherUSA MNGD. CR. PROVIDER #
FL9137OtherDIMENSION PROVIDER NUMBER
FL222166OtherAMERIGROUP PROVIDER #
FL259097OtherAVMED PROVIDER NUMBER
FL8790OtherTOTAL HLTH CH PROVIDER #
FL224268OtherWELLCARE
FLQMP000003667229OtherMOLINA MCD
FL41696OtherBCBS PROVIDER NUMBER
FL5070616OtherAETNA PROVIDER NUMBER
FL1228843OtherFIRST HEALTH PROVIDER #
FL252758800Medicaid
FL4197468OtherGHI PROVIDER NUMBER
FLP0003151OtherFLORIDA HEALTHCARE PLUS
FL170049OtherWELLCARE PROVIDER NUMBER
FL251555OtherAVMED PROVIDER NUMBER
FLFLPV00003667229OtherMOLINA MCR
FL41696OtherBCBS PROVIDER NUMBER
FL9137OtherDIMENSION PROVIDER NUMBER
FL170049OtherWELLCARE PROVIDER NUMBER
FLP0003151OtherFLORIDA HEALTHCARE PLUS