Provider Demographics
NPI:1609848274
Name:FERNANDEZ, DURESHAHWAR J (MD)
Entity Type:Individual
Prefix:
First Name:DURESHAHWAR
Middle Name:J
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DURESHAHWAR
Other - Middle Name:J
Other - Last Name:MENDONCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:205 W WINDCREST ST STE 130
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4478
Mailing Address - Country:US
Mailing Address - Phone:830-990-1404
Mailing Address - Fax:
Practice Address - Street 1:1009 S MILAM ST STE 3
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4579
Practice Address - Country:US
Practice Address - Phone:830-990-1404
Practice Address - Fax:830-992-2841
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8487207RC0200X, 207RP1001X
NMMD2022-0350207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1181489-06Medicaid
TXTXB154220Medicare PIN