Active NPI
Israel Fernando MD
- Dermatology Physician
- Burlington, IA
National Provider Identifier
1063461671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- ISRAEL FERNANDO MD
- Practice address
- 825 N 6TH St
Burlington, IA 52601-4920 - Phone
- (319) 754-9028
- Fax
- (319) 754-9038
- NPI assigned
- May 9, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Israel V Fernando, M.D.
- Title
- Owner
- Phone
- (309) 797-3713
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary |
Addresses
Primary practice location
825 N 6TH St
Burlington, IA 52601-4920
Mailing address
1588 37TH Ave
Moline, IL 61265-7213
Phone (309) 797-2713
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0268292 | Medicaid | IA |
Other names 1
- Advanced Dermatology
National Provider Directory
National Provider Directory- Tax ID family
- Advanced Dermatology
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Dermatology Physician
- Moline, IL
- NPI 1366749616
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Dermatology Physician
- Moline, IL
- NPI 1558473850
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147132800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1063461671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1588 37TH AVE",
"city": "MOLINE",
"state": "IL",
"postal_code": "612657213",
"telephone_number": "309-797-2713",
"fax_number": "309-797-9558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 N 6TH ST",
"city": "BURLINGTON",
"state": "IA",
"postal_code": "526014920",
"telephone_number": "319-754-9028",
"fax_number": "319-754-9038"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ISRAEL FERNANDO MD",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-09",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "FERNANDO",
"authorized_official_first_name": "ISRAEL",
"authorized_official_middle_name": "V",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "309-797-3713",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0268292",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Advanced Dermatology",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Burlington, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.