Provider Demographics
NPI:1972571727
Name:FERNANDEZ, MARC E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:E
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2456 N ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-5321
Mailing Address - Country:US
Mailing Address - Phone:352-513-4783
Mailing Address - Fax:352-513-4810
Practice Address - Street 1:2456 N ESSEX AVE
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-5321
Practice Address - Country:US
Practice Address - Phone:352-513-4783
Practice Address - Fax:352-513-4810
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39262208600000X
FLME68189208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1972571727OtherNPI
FL010727700Medicaid
FL010727700Medicaid