Provider Demographics
NPI:1558591925
Name:FERNANDEZ DUARTE, JOSE ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ROBERTO
Last Name:FERNANDEZ DUARTE
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 1:2180 W STATE ROAD 434
Mailing Address - Street 2:SUITE 2110
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-5041
Mailing Address - Country:US
Mailing Address - Phone:407-647-2346
Mailing Address - Fax:
Practice Address - Street 1:2180 W STATE ROAD 434
Practice Address - Street 2:SUITE 2110
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-5041
Practice Address - Country:US
Practice Address - Phone:407-647-2346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine