Provider Demographics
NPI:1437705951
Name:FERNANDES, JOHN LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LUIS
Last Name:FERNANDES
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 1:212 HAMPTONS GREEN NW
Mailing Address - Street 2:
Mailing Address - City:CALGARY
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T3A5A8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:212 HAMPTONS GREEN NW
Practice Address - Street 2:
Practice Address - City:CALGARY
Practice Address - State:ALBERTA
Practice Address - Zip Code:T3A5A8
Practice Address - Country:CA
Practice Address - Phone:403-620-1505
Practice Address - Fax:403-247-5862
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine