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General NPI Number Information
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NPI Number | 1861020497
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Entity Type | Individual
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Provider Name | JOSHUA FERNELIUS MD
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Gender | Male
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Dates
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Enumeration Date | 03/30/2020
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 1201 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1016
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Country | US
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Telephone | 314-257-8000
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Fax | 314-977-6164
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Provider Business Mailing Address
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Address Line | 1402 S GRAND BLVD # 12
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1004
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Country | US
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Telephone | 314-577-8762
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Fax | 314-268-5108
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2023010147
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 2023010147
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License Number State | MO
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