Provider Demographics
NPI:1104805662
Name:FERNANDEZ, WILLIAM NESTOR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NESTOR
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 GOLD RUSH AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5663
Mailing Address - Country:US
Mailing Address - Phone:406-465-6957
Mailing Address - Fax:406-443-3350
Practice Address - Street 1:2400 GOLD RUSH AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5663
Practice Address - Country:US
Practice Address - Phone:406-465-6957
Practice Address - Fax:406-443-3350
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTH05129Medicare UPIN