Individual
DR. LUIS FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2850 OLYMPUS DR., POCATELLO, ID 83201
(208) 239-3815
(208) 239-3814
Mailing address
2850 OLYMPUS DR., POCATELLO, ID 83201
(208) 239-3815
(208) 239-3814
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M8581
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52282
BLUE CROSS OF ID (AB)
ID
05
—
805465900
—
ID
01
—
B5763
BLUE CROSS (MC)
ID
01
—
J7855
BLUE CROSS (LV)
ID
01
—
J7863
BLUE CROSS (AF)
ID
01
—
J7871
BLUE CROSS (DW)
ID
01
—
J7889
BLUE CROSS (PO)
ID
Enumeration date
07/18/2005
Last updated
12/28/2023
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