Provider Demographics
NPI:1215003025
Name:FERNANDEZ, ERNESTO (MD)
Entity type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:
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 1:114 W UNDERWOOD ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1138
Mailing Address - Country:US
Mailing Address - Phone:407-423-3344
Mailing Address - Fax:407-423-7785
Practice Address - Street 1:114 W UNDERWOOD ST
Practice Address - Street 2:SUITE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1138
Practice Address - Country:US
Practice Address - Phone:407-423-3344
Practice Address - Fax:407-423-7785
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027387207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038285000Medicaid
FL78945Medicare PIN
FL038285000Medicaid