Mark Allen Fernandez
Internist Pediatrician Geriatric Medicine
920 West St Ste 311
Peru
, Illinois 61354-2770
Mark Allen Fernandez
Internist Pediatrician Geriatric Medicine
920 West St Ste 311
Peru
, Illinois 61354-2770
(815) 223-9322
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About
Features
Specialties
- Internist
- Geriatric Medicine
- Pediatrician
Languages spoken
- English
Location
First Address
- Mark Allen Fernandez
- 920 West St Ste 311
- Peru, IL
- Zip : 61354-2770
- Fax : (815) 223-9322
- Phone : (815) 223-9214
Second Address
- Mark Allen Fernandez
- 920 West St Ste 311
- Peru, IL
- Zip : 61354-2770
- Fax : (815) 223-9322
- Phone : (815) 223-9214
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207R00000X | Internist | 036-089936 | IL |
| Y | 111NI0900X | Internist | 036-089936 | IL |
| N | 207RG0300X | Geriatric Medicine | 036089936 | IL |
| N | 208000000X | Pediatrician | 036089936 | IL |
National Provider Identifier
| NPI | 1033114939 |
|---|---|
| Provider Name | Mark Allen Fernandez |
| First Address | Peru, IL 61354-2770 |
| Second Address | Peru, IL 61354-2770 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 16/06/2005 |
| Last Update Date | 20/11/2008 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 036089936 | (05) | IL |
| C52077 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.