Individual
RAYMOND FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2508 W VIRGINIA AVE, SUITE B, TAMPA, FL 33607-6326
(813) 878-2191
(813) 872-2659
Mailing address
1033 DR MARTIN LUTHER KING JR ST N, SUITE 108, ST PETERSBURG, FL 33701-1547
(727) 456-4250
(727) 346-1044
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
ME14404
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
058904700
—
FL
01
—
29947X
MEDICARE PTAN
FL
Enumeration date
06/30/2006
Last updated
02/03/2010
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