Provider Demographics
NPI:1114904869
Name:FERNANDEZ, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
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 1:800 MEDICAL CENTER DR
Mailing Address - Street 2:PO BOX 800
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4575
Mailing Address - Country:US
Mailing Address - Phone:507-238-8555
Mailing Address - Fax:
Practice Address - Street 1:800 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4575
Practice Address - Country:US
Practice Address - Phone:507-238-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38613208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00T97FEMedicaid
MN7424OtherAVERA
MN89026000Medicaid
MNHP30144OtherHEALTHPARTNERS
MN17-01033OtherMEDICA
MNMH9041010113OtherPREFERREDONE
IA976373Medicaid
MN00T97FEOtherBLUE CROSS
MN120141Medicaid
MN705220OtherARAZ
MN22694OtherSIOUX VALLEY
MNA022OtherCHAMPUS
MN20002054Medicare ID - Type Unspecified
MN00T97FEMedicare ID - Type UnspecifiedBC MEDICARE SUPPLEMENT
IA976373Medicaid
MNMH9041010113OtherPREFERREDONE
MN20002054Medicare NSC