Individual
ULISES D FERNANDEZ MIRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1874 SE PORT ST LUCIE BLVD, PORT ST LUCIE, FL 34952-5545
(772) 337-7676
(772) 337-9034
Mailing address
1149 SAN MICHELE WAY, PALM BEACH GARDENS, FL 33418-6704
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME0076116
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050088996
RR MEDICARE
FL
05
—
254498900
—
FL
01
—
43618
BCBS FLORIDA
FL
Enumeration date
05/26/2006
Last updated
06/08/2011
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