Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | MD461690 | PA |
NPI | 1073741484 |
---|---|
Provider Name | Joseph S Fernandez-Moure |
First Address | Philadlephia, PA 19104 |
Second Address | Philadelphia, PA 19104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2009 |
Last Update Date | 09/08/2018 |