Provider Demographics
NPI:1578895314
Name:FERNANDEZ, JORGE ARTURO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ARTURO
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 1:7100 W 20TH AVE STE 803
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1814
Mailing Address - Country:US
Mailing Address - Phone:305-819-1104
Mailing Address - Fax:305-819-1107
Practice Address - Street 1:7100 W 20TH AVE STE 803
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1814
Practice Address - Country:US
Practice Address - Phone:305-819-1104
Practice Address - Fax:305-819-1107
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL937522471S1302X
FL108827207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography