Provider Demographics
NPI:1740592609
Name:GIL FERNANDEZ-YERA,MD,PA
Entity Type:Organization
Organization Name:GIL FERNANDEZ-YERA,MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ-YERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-441-6950
Mailing Address - Street 1:3971 SW 8TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2950
Mailing Address - Country:US
Mailing Address - Phone:305-441-6950
Mailing Address - Fax:
Practice Address - Street 1:3971 SW 8TH ST STE 201
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2950
Practice Address - Country:US
Practice Address - Phone:305-441-6950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43068305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068058300Medicaid
FLME43068OtherLICENSE
FL068058300Medicaid