Provider Demographics
NPI:1740365311
Name:FERNANDEZ, RALPH JOSEPH JR (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:JOSEPH
Last Name:FERNANDEZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R.
Other - Middle Name:JOSEPH
Other - Last Name:FERNANDEZ
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-4278
Practice Address - Street 1:4640 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6902
Practice Address - Country:US
Practice Address - Phone:337-984-1050
Practice Address - Fax:337-365-8421
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.018206207V00000X
LA018206207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1385573Medicaid
LAD73598Medicare UPIN
LA1385573Medicaid