1275521510 NPI number — DR. DENNIS LAYSON FERNANDEZ MEDICAL DOCTOR

Table of content: DR. DENNIS LAYSON FERNANDEZ MEDICAL DOCTOR (NPI 1275521510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275521510 NPI number — DR. DENNIS LAYSON FERNANDEZ MEDICAL DOCTOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERNANDEZ
Provider First Name:
DENNIS
Provider Middle Name:
LAYSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MEDICAL DOCTOR
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275521510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4025 PEPPERWOOD CIR SW
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-7433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-882-1908
Provider Business Mailing Address Fax Number:
256-882-1907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4025 PEPPERWOOD CIR SW
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-7433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-882-1908
Provider Business Practice Location Address Fax Number:
256-882-1907
Provider Enumeration Date:
10/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  00025395 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0102X , with the licence number: 00025395 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009935184 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1649439472 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051532507 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com