Provider Demographics
NPI:1639463086
Name:FERNANDEZ, DERYCK ROMEO (DPM)
Entity Type:Individual
Prefix:DR
First Name:DERYCK
Middle Name:ROMEO
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8190 ROYAL PALM BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5706
Mailing Address - Country:US
Mailing Address - Phone:954-346-5077
Mailing Address - Fax:
Practice Address - Street 1:8190 ROYAL PALM BLVD STE 203
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5706
Practice Address - Country:US
Practice Address - Phone:954-346-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3674213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery