Individual
JOSS D FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1605 E BROADWAY STE 210, COLUMBIA, MO 65201-8023
(573) 815-4130
(573) 815-4135
Mailing address
1605 E BROADWAY STE 210, COLUMBIA, MO 65201-8023
(573) 815-4130
(573) 815-4135
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
37854
IA
2086S0129X
Vascular Surgery Physician
37854
IA
2086S0129X
Vascular Surgery Physician
39993
TN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
2012006733
MO
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
37854
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09016196
—
MS
05
—
162992001
—
AR
05
—
3825158
—
TN
01
—
62-1719735
TAX ID #
TN
Enumeration date
06/15/2006
Last updated
09/22/2021
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