Provider Demographics
NPI:1174902944
Name:LUIS FERNANDEZ, MD
Entity type:Organization
Organization Name:LUIS FERNANDEZ, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:FELIPE
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-764-7999
Mailing Address - Street 1:2625 TAMIAMI TRL
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-6403
Mailing Address - Country:US
Mailing Address - Phone:941-661-3434
Mailing Address - Fax:941-764-7039
Practice Address - Street 1:2625 TAMIAMI TRL
Practice Address - Street 2:SUITE 5
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6403
Practice Address - Country:US
Practice Address - Phone:941-661-3434
Practice Address - Fax:941-764-7039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56435332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site