Provider Demographics
NPI:1912252107
Name:FERNANDEZ, ALFREDO J (MD)
Entity type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:J
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3430 W LAMBRIGHT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4750
Mailing Address - Country:US
Mailing Address - Phone:813-877-4201
Mailing Address - Fax:727-498-0672
Practice Address - Street 1:3430 W LAMBRIGHT ST STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4750
Practice Address - Country:US
Practice Address - Phone:813-877-4201
Practice Address - Fax:727-498-0672
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142805208D00000X
PR18,491208D00000X
FLACN462208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008156000Medicaid
FLHA910ZMedicare PIN