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General NPI Number Information
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NPI Number | 1174770614
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Entity Type | Individual
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Provider Name | HENRIQUE JOSE FERNANDEZ MD
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Gender | Male
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 1600 N GRAND AVE SUITE 150
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City | PUEBLO
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State | CO
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Zip | 81003-2749
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Country | US
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Telephone | 719-595-7680
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Fax | 719-595-7687
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Provider Business Mailing Address
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Address Line | 5820 GLADSTONE ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-8256
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Country | US
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Telephone | 719-576-0263
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD-50732
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 98813
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | TRN11230
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 48454
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License Number State | CO
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