Provider Demographics
NPI:1215119623
Name:WILLIAM FERNANDEZ MD PLLC
Entity type:Organization
Organization Name:WILLIAM FERNANDEZ MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-442-6969
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000083075OtherMEDICARE GROUP NUMBER