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General NPI Number Information
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NPI Number | 1235173642
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Entity Type | Individual
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Provider Name | JOSS D FERNANDEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 1605 E BROADWAY STE 210
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City | COLUMBIA
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State | MO
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Zip | 65201-8023
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Country | US
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Telephone | 573-815-4130
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Fax | 573-815-4135
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Provider Business Mailing Address
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Address Line | 1605 E BROADWAY STE 210
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City | COLUMBIA
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State | MO
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Zip | 65201-8023
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Country | US
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Telephone | 573-815-4130
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Fax | 573-815-4135
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 37854
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 37854
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 37854
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 39993
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 2012006733
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License Number State | MO
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