Provider Demographics
NPI:1932190394
Name:FERNANDEZ, LUIS F (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:F
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:PO BOX 495477
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-5477
Mailing Address - Country:US
Mailing Address - Phone:941-764-7999
Mailing Address - Fax:941-764-7039
Practice Address - Street 1:2400 HARBOR BLVD
Practice Address - Street 2:STE 5
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5052
Practice Address - Country:US
Practice Address - Phone:941-764-7999
Practice Address - Fax:941-764-7039
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56435207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10091AMedicare ID - Type Unspecified
FLE18769Medicare UPIN