Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD446571 | PA |
NPI | 1316171408 |
---|---|
Provider Name | Dr. John Gregory Fernandez |
First Address | Philadelphia, PA 19124-3808 |
Second Address | Philadelphia, PA 19124-3808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2009 |
Last Update Date | 22/06/2015 |