Provider Demographics
NPI:1831255991
Name:FERNANDEZ, ENRIQUE SALAZAR (MD)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:SALAZAR
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 1:12401 SW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4213
Mailing Address - Country:US
Mailing Address - Phone:305-720-6022
Mailing Address - Fax:
Practice Address - Street 1:10271 SW 72ND ST # D-102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3024
Practice Address - Country:US
Practice Address - Phone:305-226-4048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43406Medicare UPIN