Provider Demographics
NPI:1366670796
Name:FERNANDO FERNANDEZ, M. D. PC
Entity Type:Organization
Organization Name:FERNANDO FERNANDEZ, M. D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-421-0188
Mailing Address - Street 1:2750 CLAY EDWARDS DR STE 320
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3259
Mailing Address - Country:US
Mailing Address - Phone:816-421-0188
Mailing Address - Fax:816-421-0874
Practice Address - Street 1:2750 CLAY EDWARDS DR STE 320
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3259
Practice Address - Country:US
Practice Address - Phone:816-421-0188
Practice Address - Fax:816-421-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201227717Medicaid