Provider Demographics
NPI:1679558928
Name:DAVID F FERNANDEZ, MD, PA
Entity Type:Organization
Organization Name:DAVID F FERNANDEZ, MD, PA
Other - Org Name:LAKESIDE INTERNAL MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-343-0677
Mailing Address - Street 1:1879 NIGHTINGALE LN
Mailing Address - Street 2:SUITE B1
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4363
Mailing Address - Country:US
Mailing Address - Phone:352-343-5722
Mailing Address - Fax:352-343-7506
Practice Address - Street 1:1879 NIGHTINGALE LN
Practice Address - Street 2:SUITE B1
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4363
Practice Address - Country:US
Practice Address - Phone:352-343-5722
Practice Address - Fax:352-343-7506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45546OtherBLUE CROSS BLUE SHEILD FL
FLK2140Medicare PIN