Provider Demographics
NPI:1831135953
Name:FERNANDEZ, JIM B (MD)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:B
Last Name:FERNANDEZ
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 1:900 W 38TH ST
Mailing Address - Street 2:#300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1127
Mailing Address - Country:US
Mailing Address - Phone:512-450-1300
Mailing Address - Fax:512-450-1339
Practice Address - Street 1:900 W 38TH ST
Practice Address - Street 2:#300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1127
Practice Address - Country:US
Practice Address - Phone:512-450-1300
Practice Address - Fax:512-450-1339
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL22462081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1278600001OtherMEDICARE SUPPLIER NUMBER
TX149109402Medicaid
TXL2246OtherTEXAS MEDICAL BOARD
TX1278600001Medicare NSC
TXL2246OtherTEXAS MEDICAL BOARD
8636NOMedicare ID - Type Unspecified