Federico Gonzalez-Fernandez, MD
Individual provider Active NPI Anatomic Pathology Physician · Jackson, MS
NPI 1205808342 · NPPES record last updated Jan 18, 2017
Key facts
- NPI
- 1205808342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anatomic Pathology Physician 207ZP0101X
- License
- 23727 (MS)
- Practice address
- 2500 N State St
Jackson, MS 39216-4500 - Phone
- (601) 984-5017
- Fax
- (601) 984-5042
- NPI assigned
- Feb 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150512000508 | MS | Practitioner - Pathology | 6204825839 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of Mississippi - University of Mississippi Medical Center | Current |
Accepting new patients | |
| State of Mississippi - University of Mississippi Medical Center | Current |
Accepting new patients |
Locations
2500 N State St
Jackson, MS 39216
Phone (601) 815-4775
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology Physician | 207ZP0101X | 225230 | NY | |
| Anatomic Pathology Physician | 207ZP0101X | 23727 | MS | Yes |
Addresses
Primary practice location
2500 N State St
Jackson, MS 39216-4500
Mailing address
2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-5017
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03731244 | Medicaid | MS |
Other providers in Jackson, MS
- Fernando Gomez
- Taillk Goncalves Gomes
- Stephanie Gong
- Gian Emmanuel Gonzalez Quiles
- Ezekiel Gonzalez-Fernandez
- Victoria Beatriz Gonzalez
- Good Faith Health Services
- Anna Peyton Goodbread
- Miles Goode Jr.
- Sherilyn Sanders Goode
All providers in Jackson, MS · Anatomic Pathology Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.