Provider Demographics
NPI:1629017397
Name:FERNANDEZ, FELIX L (DO)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:L
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 COOLIDGE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-4672
Mailing Address - Country:US
Mailing Address - Phone:423-636-2700
Mailing Address - Fax:423-232-8573
Practice Address - Street 1:1021 COOLIDGE ST STE 2
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4672
Practice Address - Country:US
Practice Address - Phone:423-636-2700
Practice Address - Fax:423-232-8573
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8556207Q00000X
TN2692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266233700Medicaid
TN6023306OtherBCBS
TNGROUP: Q007322Medicaid
TNQ006673Medicaid
TN103I086048Medicare PIN
TN6023306OtherBCBS
FL57642YMedicare PIN
TNGROUP: 103G709321Medicare PIN
FLP00411904Medicare PIN
FL266233700Medicaid