Individual
MR. JOSEPH P FERNANDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2340 KATY LN, SUITE 120, POPLAR BLUFF, MO 63901-2300
(573) 776-7393
(573) 776-7396
Mailing address
2340 KATY LN, SUITE 120, POPLAR BLUFF, MO 63901-2300
(573) 776-7393
(573) 776-7396
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
112068
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208897603
—
MO
Enumeration date
11/01/2006
Last updated
05/09/2016
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