Provider Demographics
NPI:1639108830
Name:FERNANDES, EDUARDO TAVORA (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:TAVORA
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:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 394
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-6666
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE STREET SE, PWB FIRST FLOOR, CLINIC 1E
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN36795208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0147459Medicaid
MN1016618OtherPREFERRED ONE
MN19-00018OtherMEDICA PRIMARY
MN777876OtherARAZ
IA0596908Medicaid
MN383R1FEOtherBCBS
MN122707OtherUCARE
MN19-00526OtherMEDICA CHOICE
MNHP26223OtherHEALTHPARTNERS
MN19-00018OtherMEDICA PRIMARY