Provider Demographics
NPI:1114927258
Name:FERNANDEZ, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
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 1:613 ELIZABETH ST SUITE 601
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404
Mailing Address - Country:US
Mailing Address - Phone:361-888-7082
Mailing Address - Fax:361-888-7084
Practice Address - Street 1:613 ELIZABETH ST SUITE 601
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404
Practice Address - Country:US
Practice Address - Phone:361-888-7082
Practice Address - Fax:361-888-7084
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2019-09-26
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-06-27
Provider Licenses
StateLicense IDTaxonomies
TXH8925174400000X, 2082S0105X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116146504Medicaid
TX8A4998Medicare ID - Type Unspecified