Provider Demographics
NPI:1619387925
Name:INTERNAL MEDICINE OF SOUTH FL LLC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF SOUTH FL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-304-9071
Mailing Address - Street 1:12264 TAMIAMI TRL E
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-7942
Mailing Address - Country:US
Mailing Address - Phone:239-304-9071
Mailing Address - Fax:
Practice Address - Street 1:12264 TAMIAMI TRL E
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-7942
Practice Address - Country:US
Practice Address - Phone:239-304-9071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERNAL MEDICINE OF SOUTH FL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14LR2OtherBLUE CROSS BLUE SHIELD