Provider Demographics
NPI:1043612526
Name:EDGAR E. FERNANDEZ MD PA
Entity Type:Organization
Organization Name:EDGAR E. FERNANDEZ MD PA
Other - Org Name:BORDER CITY ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:E
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-274-4082
Mailing Address - Street 1:5959 GATEWAY BLVD W STE 120
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3315
Mailing Address - Country:US
Mailing Address - Phone:915-779-1716
Mailing Address - Fax:915-779-1754
Practice Address - Street 1:1512 ZARAGOZA ROAD
Practice Address - Street 2:BUILDING C STE 3-4
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-8903
Practice Address - Country:US
Practice Address - Phone:915-206-2120
Practice Address - Fax:915-206-2130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0045207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty