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NPI Code Detail

MEDICARE: EDGAR E. FERNANDEZ MD PA

MEDICARE: EDGAR E. FERNANDEZ MD PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207X00000XOrthopaedic Surgery PhysicianQ0045TX

General Provider Information

NPI Number : 1043612526
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDGAR E. FERNANDEZ MD PA
Provider Business Mailing Address
First Line : 5959 GATEWAY BLVD W STE 120
Second Line :
City : EL PASO
State : TX
Zip : 79925-3315
Country : US
Telephone Number : 915-779-1716
Fax Number : 915-779-1754
Provider Business Practice Location Address
First Line : 1512 ZARAGOZA ROAD
Second Line : BUILDING C STE 3-4
City : EL PASO
State : TX
Zip : 79936-8903
Country : US
Telephone Number : 915-206-2120
Fax Number : 915-206-2130
Authorized Official
Title or Position : DIRECTOR
Name : EDGAR E FERNANDEZ
Credential : MD
Telephone Number : 915-274-4082
Provider Enumeration Date : 09/16/2014
Last Update Date : 12/04/2018

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