Provider Demographics
NPI:1942233929
Name:MEMBRENO, FERNANDO E (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:E
Last Name:MEMBRENO
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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-2410
Mailing Address - Fax:956-362-2414
Practice Address - Street 1:1100 E DOVE AVE STE 202
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4681
Practice Address - Country:US
Practice Address - Phone:956-362-2410
Practice Address - Fax:956-362-2414
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4350207RI0008X, 207RT0003X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181292711Medicaid
279044YLLWOtherMEDICARE
TX181292708Medicaid