Provider Demographics
NPI:1003043464
Name:FERNANDEZ, FERNANDO (DPM)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9303 PINECROFT DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3180
Mailing Address - Country:US
Mailing Address - Phone:281-292-7000
Mailing Address - Fax:281-292-5222
Practice Address - Street 1:9303 PINECROFT DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3180
Practice Address - Country:US
Practice Address - Phone:281-292-7000
Practice Address - Fax:281-292-5222
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1898213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207219101Medicaid
463176ZSELMedicare PIN
TX207219101Medicaid
TX1003043464Medicare PIN