Individual
CORY JAMES FERNANDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4481 VIKING DR, BOSSIER CITY, LA 71111-7414
(318) 626-2593
(318) 399-7716
Mailing address
3307 FAIRFIELD AVE, SHREVEPORT, LA 71104-4103
(818) 388-9705
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
341893
LA
207Q00000X
Family Medicine Physician
T4919
TX
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/26/2018
Last updated
04/09/2025
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