Provider Demographics
NPI:1558410522
Name:FERNANDEZ, ROBERT C (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
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 1:4890 W KENNEDY BLVD
Mailing Address - Street 2:SUITE 990
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1851
Mailing Address - Country:US
Mailing Address - Phone:813-288-1564
Mailing Address - Fax:813-288-7317
Practice Address - Street 1:4890 W KENNEDY BLVD
Practice Address - Street 2:SUITE 990
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1851
Practice Address - Country:US
Practice Address - Phone:813-288-1564
Practice Address - Fax:813-288-7317
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00158552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD53840Medicare UPIN
FL30075Medicare ID - Type UnspecifiedMEDICARE NUMBER