| Luis F Fernandez | |
|
2400 Harbor Blvd Ste 5 Port Charlotte FL 33952-5038 | |
| (941) 764-7999 | |
| (941) 764-7039 |
| Full Name | Luis F Fernandez |
|---|---|
| Speciality | Internal Medicine |
| Location | 2400 Harbor Blvd Ste 5, Port Charlotte, Florida |
| Authorized Official Name and Position | Luis F Fernandez (OWNER) |
| Authorized Official Contact | 9416613434 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Luis F Fernandez Po Box 495477 Port Charlotte FL 33949-5477 Ph: (941) 766-1901 | Luis F Fernandez 2400 Harbor Blvd Ste 5 Port Charlotte FL 33952-5038 Ph: (941) 764-7999 |
| NPI Number | 1861150773 |
|---|---|
| Provider Enumeration Date | 12/08/2021 |
| Last Update Date | 06/07/2022 |
| Medicare PECOS PAC ID | 8022492461 |
|---|---|
| Medicare Enrollment ID | O20220901003627 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861150773 | NPI | - | NPPES |
| 10091A | Other | FL | MEDICARE |
| ME0056435 | Other | FL | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Luis F Fernandez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932190394 PECOS PAC ID: 4789587494 Enrollment ID: I20040129001145 |
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