1114063997 NPI number — JUAN A. FERNANDEZ, MD ADVANCED UROLOGY, PC

Table of content: (NPI 1114063997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114063997 NPI number — JUAN A. FERNANDEZ, MD ADVANCED UROLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUAN A. FERNANDEZ, MD ADVANCED UROLOGY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114063997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2126 W ROY PARKER RD
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
OZARK
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36360-8566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-774-1200
Provider Business Mailing Address Fax Number:
334-774-1204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2126 W ROY PARKER RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
OZARK
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36360-8566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-774-1200
Provider Business Practice Location Address Fax Number:
334-774-1204
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FERNANDEZ
Authorized Official First Name:
JUAN
Authorized Official Middle Name:
ALBERTO
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
334-774-1200

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  27725 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com