Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 15894 | AZ |
N | 207RP1001X | Pulmonary Disease | 15894 | AZ |
NPI | 1023001963 |
---|---|
Provider Name | Dr. Norman M Fernando |
First Address | Phoenix, AZ 85015-1631 |
Second Address | Phoenix, AZ 85015-1631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2005 |
Last Update Date | 01/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
254293 | (05) | AZ |
A14500 | (02) | AZ |