Provider Demographics
NPI:1952418626
Name:FERNANDEZ, ROMEO K (MD)
Entity Type:Individual
Prefix:
First Name:ROMEO
Middle Name:K
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 1:7000 W PALMETTO PARK RD STE 307
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3430
Mailing Address - Country:US
Mailing Address - Phone:561-288-5990
Mailing Address - Fax:954-391-5008
Practice Address - Street 1:7000 W PALMETTO PARK RD STE 307
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3430
Practice Address - Country:US
Practice Address - Phone:561-288-5990
Practice Address - Fax:954-391-5008
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261512084N0402X
FLME959282084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275996900OtherFL NETPASS
FL275996900Medicaid
AL009960356Medicaid
AL009960355Medicaid
FL303912OtherAVMED
FL56286OtherBCBS
FL275996900OtherPHYTRUST OF FLORIDA PSN
FL275996900OtherPEDIATRICS ASSOCIATES PSN
I24327Medicare UPIN
051523472Medicare ID - Type Unspecified
FL275996900Medicaid