Provider Demographics
NPI:1346317054
Name:FERNANDEZ, ERNESTO M (MD)
Entity Type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:M
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 1:8355 WALNUT HILL LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4219
Mailing Address - Country:US
Mailing Address - Phone:214-987-0117
Mailing Address - Fax:214-691-8801
Practice Address - Street 1:8355 WALNUT HILL LN
Practice Address - Street 2:SUITE 105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4219
Practice Address - Country:US
Practice Address - Phone:214-987-0117
Practice Address - Fax:214-691-8801
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5767208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
E10594Medicare UPIN