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NPI Code Detail

MEDICARE: JOHN J FERNANDES DO

MEDICARE: JOHN J FERNANDES DO
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
1207ZP0105XClinical Pathology/Laboratory Medicine Physician4071OK

General Provider Information

NPI Number : 1538138169
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN J FERNANDES DO
Provider Business Mailing Address
First Line : 2345 SOUTHWEST BLVD
Second Line :
City : TULSA
State : OK
Zip : 74107-2705
Country : US
Telephone Number : 918-582-1980
Fax Number :
Provider Business Practice Location Address
First Line : 2345 SOUTHWEST BLVD
Second Line :
City : TULSA
State : OK
Zip : 74107-2705
Country : US
Telephone Number : 918-582-1980
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 09/17/2008

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