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General NPI Number Information
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NPI Number | 1114193174
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Entity Type | Organization
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Legal Business Name | RUDY S FERNANDEZ MD PC
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 11/24/2010
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Provider Practice Location Address
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Address Line | 1023 WATERWOOD PKWY
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City | EDMOND
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State | OK
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Zip | 73034-5324
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Country | US
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Telephone | 405-513-7226
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Fax | 405-513-5620
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Provider Business Mailing Address
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Address Line | 1023 WATERWOOD PKWY
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City | EDMOND
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State | OK
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Zip | 73034-5324
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Country | US
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Telephone | 405-513-7226
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Fax | 405-513-5620
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Authorized Official
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Title or Position | OWNER
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Name | RODOLFO FERNANDEZ
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Credential | MD
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Telephone | 405-513-7226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number | 20140
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License Number State | OK
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