Provider Demographics
NPI:1295800381
Name:FERNANDEZ, GONZALO ANDRES (MD)
Entity type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:ANDRES
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:112 DONMOOR CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2500
Mailing Address - Country:US
Mailing Address - Phone:919-661-0801
Mailing Address - Fax:919-661-0807
Practice Address - Street 1:112 DONMOOR CT
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-2500
Practice Address - Country:US
Practice Address - Phone:919-661-0801
Practice Address - Fax:919-661-0807
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH03813Medicare UPIN