Individual
LUIS G FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
910 E HOUSTON ST, STE 530, TYLER, TX 75702-8369
(903) 531-5560
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
2086S0127X
Trauma Surgery Physician
Primary
J5320
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110504103
—
TX
05
—
110504104
—
TX
01
—
86510S
BCBS
TX
01
—
8BC268
BCBS OF TEXAS
TX
01
—
TIN PLUS 096
TRICARE
TX
Enumeration date
05/17/2006
Last updated
10/13/2014
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