Provider Demographics
NPI:1891447694
Name:PRIORITY HEALTH MD INC
Entity Type:Organization
Organization Name:PRIORITY HEALTH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ-BLAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-890-2524
Mailing Address - Street 1:4765 SW 148TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2127
Mailing Address - Country:US
Mailing Address - Phone:954-374-7545
Mailing Address - Fax:
Practice Address - Street 1:9999 SHERIDAN ST STE 120
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-3086
Practice Address - Country:US
Practice Address - Phone:954-589-1198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-23
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty