Provider Demographics
NPI:1972594505
Name:FERNANDEZ, FREDERICO YAMBAO (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICO
Middle Name:YAMBAO
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 1:2804 GREENHILL BLVD NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3066
Mailing Address - Country:US
Mailing Address - Phone:256-845-0023
Mailing Address - Fax:256-845-0238
Practice Address - Street 1:2804 GREENHILL BLVD NW
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3066
Practice Address - Country:US
Practice Address - Phone:256-845-0023
Practice Address - Fax:256-845-0238
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21001207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000098779Medicare ID - Type Unspecified
ALG19129Medicare UPIN