Provider Demographics
NPI:1437130788
Name:FERNANDEZ, JOSE M JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:FERNANDEZ
Suffix:JR
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 1:2800 S MACGREGOR WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-1032
Mailing Address - Country:US
Mailing Address - Phone:713-741-5000
Mailing Address - Fax:713-741-5049
Practice Address - Street 1:2800 S MACGREGOR WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-1032
Practice Address - Country:US
Practice Address - Phone:713-741-5000
Practice Address - Fax:713-741-5049
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ41082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122020406Medicaid
TX122020403Medicaid
TXP00401440Medicaid
TX122020403Medicaid
TX122020406Medicaid
TX8E0432Medicare PIN