Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 703 | SC |
Y | 213EP1101X | Primary Podiatric Medicine | 771 | NC |
N | 213ES0103X | Foot & Ankle Surgery | 703 | SC |
NPI | 1194259341 |
---|---|
Provider Name | Dr. Matthew Fernandez |
First Address | Elkin, NC 28621-2445 |
Second Address | Charleston, SC 29414-5719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2017 |
Last Update Date | 09/12/2021 |