Provider Demographics
NPI:1861442907
Name:ALFREDO FERNANDEZ, MD, PA
Entity Type:Organization
Organization Name:ALFREDO FERNANDEZ, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-496-9663
Mailing Address - Street 1:6101 WEBB RD
Mailing Address - Street 2:#101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2872
Mailing Address - Country:US
Mailing Address - Phone:813-496-9663
Mailing Address - Fax:813-496-9921
Practice Address - Street 1:6101 WEBB RD
Practice Address - Street 2:#101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2872
Practice Address - Country:US
Practice Address - Phone:813-496-9663
Practice Address - Fax:813-496-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30920Medicare ID - Type Unspecified