Provider Demographics
NPI:1932214491
Name:JOSE R FERNANDEZ MDPA
Entity type:Organization
Organization Name:JOSE R FERNANDEZ MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-782-4002
Mailing Address - Street 1:420 W SAM HOUSTON ST STE A
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5311
Mailing Address - Country:US
Mailing Address - Phone:956-782-4002
Mailing Address - Fax:956-782-4004
Practice Address - Street 1:420 W SAM HOUSTON ST STE A
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5311
Practice Address - Country:US
Practice Address - Phone:956-782-4002
Practice Address - Fax:956-782-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7954207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty