Provider Demographics
NPI:1205368701
Name:FERNANDEZ, EDGAR SERGE (MD)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:SERGE
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 1:1012 LUCERNE TER
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1015
Mailing Address - Country:US
Mailing Address - Phone:407-423-1039
Mailing Address - Fax:407-425-2347
Practice Address - Street 1:1012 LUCERNE TER
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1015
Practice Address - Country:US
Practice Address - Phone:407-423-1039
Practice Address - Fax:407-425-2347
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME143670207R00000X, 207RI0200X
AZ72796207RI0200X
WI84410-20207RI0200X
MN3008207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME143670OtherSTATE LICENSE
FL109063800Medicaid