Provider Demographics
NPI:1255645255
Name:FERNANDEZ, VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
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 1:722 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-7008
Mailing Address - Country:US
Mailing Address - Phone:954-345-4333
Mailing Address - Fax:954-345-4334
Practice Address - Street 1:722 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-7008
Practice Address - Country:US
Practice Address - Phone:954-345-4333
Practice Address - Fax:954-345-4334
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60258126207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology