Provider Demographics
NPI:1972656247
Name:FERNANDEZ, NOEL DE JESUS (MD)
Entity Type:Individual
Prefix:MR
First Name:NOEL
Middle Name:DE JESUS
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 1:1975 W 76TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3269
Mailing Address - Country:US
Mailing Address - Phone:786-703-1535
Mailing Address - Fax:305-397-2725
Practice Address - Street 1:1975 W 76TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3269
Practice Address - Country:US
Practice Address - Phone:786-703-1535
Practice Address - Fax:305-397-2725
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50044OtherMEDICARE PTAN
FL272344100Medicaid