Provider Demographics
NPI:1063516284
Name:FERNANDEZ, JOSE RAMON (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAMON
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 1:300 N. JOHN YOUNG PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMME
Mailing Address - State:FL
Mailing Address - Zip Code:34141
Mailing Address - Country:US
Mailing Address - Phone:407-935-9012
Mailing Address - Fax:407-935-9108
Practice Address - Street 1:300 N. JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMME
Practice Address - State:FL
Practice Address - Zip Code:34141
Practice Address - Country:US
Practice Address - Phone:407-935-9012
Practice Address - Fax:407-935-9108
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63085207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371432201Medicaid
FL371432201Medicaid
FL18236TMedicare ID - Type Unspecified