Provider Demographics
NPI:1861467078
Name:FERNANDES, RUI PAULO (MD , DMD)
Entity type:Individual
Prefix:DR
First Name:RUI
Middle Name:PAULO
Last Name:FERNANDES
Suffix:
Gender:M
Credentials:MD , DMD
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 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP ORAL MAXILLOFACIAL SURGERY
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-3216
Practice Address - Fax:904-244-3218
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDTP453122300000X
ALD00049201223S0112X
GADN1232871223S0112X
FLME93053208600000X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA846801174AMedicaid
FL2723425-00Medicaid
FL0760986-00Medicaid
FL0760986-00Medicaid
FL03511ZMedicare PIN
GA846801174AMedicaid