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NPI Code Detail

MEDICARE: LIBERTAD FERNANDEZ GEAN PA

MEDICARE: LIBERTAD FERNANDEZ GEAN PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA05015TX

General Provider Information

NPI Number : 1174866115
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIBERTAD FERNANDEZ GEAN PA
Provider Business Mailing Address
First Line : 5917 BELT LINE RD
Second Line :
City : DALLAS
State : TX
Zip : 75254-7703
Country : US
Telephone Number : 972-726-6262
Fax Number : 972-726-6444
Provider Business Practice Location Address
First Line : 5917 BELT LINE RD
Second Line :
City : DALLAS
State : TX
Zip : 75254-7703
Country : US
Telephone Number : 972-726-6464
Fax Number : 972-726-6444
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2013
Last Update Date : 02/09/2024

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Directions to “ LIBERTAD FERNANDEZ GEAN PA” Practice Location

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