Provider Demographics
NPI:1609121136
Name:FERNANDEZ, THOMAS MARK ANTONY (MBCHB)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARK ANTONY
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MBCHB
Other - Prefix:
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Mailing Address - Street 1:2056 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1238
Mailing Address - Country:US
Mailing Address - Phone:415-657-6225
Mailing Address - Fax:
Practice Address - Street 1:521 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0648
Practice Address - Country:US
Practice Address - Phone:415-476-9035
Practice Address - Fax:415-514-1532
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAF 5717207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology