MEDICARE: BARRY FERNANDO MD

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
1	2086S0122X	Plastic and Reconstructive Surgery Physician	17802	AZ

General Provider Information

NPI Number	:	1104817378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY FERNANDO MD

Provider Business Mailing Address
First Line	:	2777 E CAMELBACK RD STE 140
Second Line	:	140
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4351
Country	:	US
Telephone Number	:	602-956-3596
Fax Number	:	602-956-4762

Provider Business Practice Location Address
First Line	:	2777 E CAMELBACK RD STE 140
Second Line	:	#780
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4351
Country	:	US
Telephone Number	:	602-956-3596
Fax Number	:	602-956-4762

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	03/07/2023

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