Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 04-31540 | KS |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 04-31540 | KS |
N | 207XS0117X | Orthopaedic Spine Surgeon | 0431540 | KS |
NPI | 1629003223 |
---|---|
Provider Name | Dr. Gerard Fernandez Librodo |
First Address | El Dorado, KS 67042-2187 |
Second Address | El Dorado, KS 67042-2187 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 26/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000106013 | BLUE CROSS BLUE SHIELD (01) | KS |
200373470C | (05) | KS |
I51832 | (02) |