Individual
JAXON JAMES FERNANDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 CLARA MAASS DR, BELLEVILLE, NJ 07109-3550
(973) 450-2000
Mailing address
PO BOX 708640, SANDY, UT 84070-8640
(866) 869-2395
(801) 352-9502
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA08153000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0125237
—
NJ
01
—
P00399307
RAIL ROAD MEDICARE
NJ
Enumeration date
12/15/2006
Last updated
10/24/2007
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