Provider Demographics
NPI:1003894726
Name:FERNANDEZ, JOSE J (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:J
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-0810
Mailing Address - Country:US
Mailing Address - Phone:603-308-1472
Mailing Address - Fax:
Practice Address - Street 1:2404 E RIVER RD
Practice Address - Street 2:BLD 2 STE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6520
Practice Address - Country:US
Practice Address - Phone:520-838-3540
Practice Address - Fax:520-325-3526
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUMC-149207RC0000X
AZ8577207RC0000X
NH32143207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ202416Medicaid
AZZ111886Medicare PIN
AZZ20492Medicare PIN
AZ202416Medicaid