Provider Demographics
NPI:1639396187
Name:DENNIS L FERNANDEZ MD PC
Entity Type:Organization
Organization Name:DENNIS L FERNANDEZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-882-1908
Mailing Address - Street 1:4025 PEPPERWOOD CIR SW
Mailing Address - Street 2:SUITE C
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-7433
Mailing Address - Country:US
Mailing Address - Phone:256-882-1908
Mailing Address - Fax:256-882-1907
Practice Address - Street 1:4025 PEPPERWOOD CIR SW
Practice Address - Street 2:SUITE C
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-7433
Practice Address - Country:US
Practice Address - Phone:256-882-1908
Practice Address - Fax:256-882-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25395208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009935184Medicaid
AL1649439472Medicaid
AL009935184Medicaid
AL1649439472Medicaid