Provider Demographics
NPI:1033222435
Name:FERNANDEZ, JUAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:H
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7014
Mailing Address - Country:US
Mailing Address - Phone:336-275-5391
Mailing Address - Fax:336-275-4702
Practice Address - Street 1:719 GREEN VALLEY RD
Practice Address - Street 2:SUITE 305
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-275-5391
Practice Address - Fax:336-275-4702
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33037174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE06703Medicare UPIN