Provider Demographics
NPI:1851568950
Name:FERNANDEZ, JIMMY DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:DANIEL
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 1:8226 SAN FIDEL WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-2303
Mailing Address - Country:US
Mailing Address - Phone:305-987-2699
Mailing Address - Fax:
Practice Address - Street 1:18414 US HIGHWAY 281 N
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-7610
Practice Address - Country:US
Practice Address - Phone:210-495-0222
Practice Address - Fax:210-495-5914
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108498207R00000X
TXP1301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX292048YSQEMedicare PIN