Healthcare Provider Details

I. General information

NPI: 1548243124
Provider Name (Legal Business Name): FERNANDO FERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 CLAY EDWARDS DR SUITE 320
NORTH KANSAS CITY MO
64116-3237
US

IV. Provider business mailing address

2750 CLAY EDWARDS DR SUITE 320
NORTH KANSAS CITY MO
64116-3237
US

V. Phone/Fax

Practice location:
  • Phone: 816-421-0188
  • Fax: 816-421-0874
Mailing address:
  • Phone: 816-421-0188
  • Fax: 816-421-0874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35399
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: