Provider Demographics
NPI:1760658520
Name:FERNANDEZ, RENE AGUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:AGUSTIN
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:50 BARRACUDA LN
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-3733
Mailing Address - Country:US
Mailing Address - Phone:305-367-2600
Mailing Address - Fax:305-367-4573
Practice Address - Street 1:50 BARRACUDA LN
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-3733
Practice Address - Country:US
Practice Address - Phone:305-367-2600
Practice Address - Fax:305-367-4573
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 63959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23711OtherBCBS
FL23711OtherBCBS
FL23711YMedicare PIN