Provider Demographics
NPI:1194475269
Name:FERNANDES, PHILIP IVAN-FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:IVAN-FRANCIS
Last Name:FERNANDES
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 1:750 WELCH RD STE 116
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1508
Mailing Address - Country:US
Mailing Address - Phone:650-725-9813
Mailing Address - Fax:
Practice Address - Street 1:750 WELCH RD STE 116
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1508
Practice Address - Country:US
Practice Address - Phone:650-725-9813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA2012302080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program