Provider Demographics
NPI:1295775948
Name:JOSEPH I FERNANDEZ MD PA
Entity type:Organization
Organization Name:JOSEPH I FERNANDEZ MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-275-5277
Mailing Address - Street 1:8940 SW 88TH ST
Mailing Address - Street 2:STE 101E
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8940 SW 88TH ST
Practice Address - Street 2:STE 101E
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2148
Practice Address - Country:US
Practice Address - Phone:305-275-5677
Practice Address - Fax:305-275-6560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60818332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
1015723OtherNCPDP PROVIDER IDENTIFICATION NUMBER