Healthcare Provider Details

I. General information

NPI: 1619084605
Provider Name (Legal Business Name): MIGUEL FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 FLOYD CURL DRIVE UTHSCSA, STPC, MSC 7849
SAN ANTONIO TX
78229-3900
US

IV. Provider business mailing address

7703 FLOYD CURL DRIVE UTHSCSA, STPC, MSC 7849
SAN ANTONIO TX
78229-3900
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberK0744
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberK0744
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: