Provider Demographics
NPI:1013073857
Name:LEFEBRE- FERNANDEZ, AMEDEE (MD)
Entity Type:Individual
Prefix:
First Name:AMEDEE
Middle Name:
Last Name:LEFEBRE- 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:PO BOX 908
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-0908
Mailing Address - Country:US
Mailing Address - Phone:787-836-8621
Mailing Address - Fax:787-836-8621
Practice Address - Street 1:503 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-1705
Practice Address - Country:US
Practice Address - Phone:787-836-8621
Practice Address - Fax:787-836-8621
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11484207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11484OtherLICENSE PR
0089843Medicare Oscar/Certification