Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 1898 | TX |
NPI | 1003043464 |
---|---|
Provider Name | Dr. Fernando Fernandez |
First Address | The Woodlands, TX 77380-3180 |
Second Address | The Woodlands, TX 77380-3180 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2009 |
Last Update Date | 01/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207219101 | (05) | TX |
8L19980 | (02) | TX |