Provider Demographics
NPI:1962457069
Name:FERNANDEZ, LUIS G (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:G
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 1:222 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1852
Mailing Address - Country:US
Mailing Address - Phone:629-255-3486
Mailing Address - Fax:
Practice Address - Street 1:2325 CRESTMOOR RD STE 201
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2045
Practice Address - Country:US
Practice Address - Phone:629-255-2136
Practice Address - Fax:629-255-4200
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36604208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3881516Medicaid
TNH20436Medicare UPIN
TN103I117054Medicare PIN
TN3881516Medicaid
TNH20436Medicare UPIN
TNH20436OtherHEALTHSPRING
TN3881517Medicare PIN
TN4058038OtherTENNCARE
TN7039325OtherAETNA
TN3881516Medicaid