CORY JAMES FERNANDES

BOSSIER CITY, LA
NPI1952892895
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy207Q00000X Family Medicine
(Licence: LA  341893)
Additional Taxonomies207Q00000X Family Medicine
(Licence: TX  T4919)
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2018-05-26
Last Update Date2025-04-09
Business Address
CORY JAMES FERNANDES DO
4481 VIKING DR
BOSSIER CITY, LA 71111-7414
Phone number: 318-626-2593
Mailing Address
CORY JAMES FERNANDES DO
3307 FAIRFIELD AVE
SHREVEPORT, LA 71104-4103
Phone number: 818-388-9705
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