Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 256396 | NY |
Y | 207N00000X | Dermatologist | 47813 | AZ |
N | 207ND0900X | Dermatopathologist | 47813 | AZ |
N | 207R00000X | Internist | MT193444 | PA |
N | 111NI0900X | Internist | MT193444 | PA |
NPI | 1669634200 |
---|---|
Provider Name | Neil F Fernandes |
First Address | Chandler, AZ 85224-5680 |
Second Address | Chandler, AZ 85224-5680 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 11/08/2021 |