Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 2901018321 | MI |
NPI | 1255442042 |
---|---|
Provider Name | Norbert Edward Fernandez |
First Address | Ann Arbor, MI 48103 |
Second Address | Ann Arbor, MI 48103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |