Organization
ISRAEL V. FERNANDO
Active
Other names
Advanced Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ISRAEL V. FERNANDO M.D. (OWNER/PHYSICIAN)
(309) 797-2713
Entity
Organization
Contact information
Practice address
1588 37TH AVE, MOLINE, IL 61265-7213
(309) 797-2713
(309) 797-9558
Mailing address
1588 37TH AVE, MOLINE, IL 61265-7213
(309) 797-2713
(309) 797-9558
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036-101791
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2252064
—
IA
Enumeration date
02/23/2011
Last updated
02/23/2011
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