Provider Demographics
NPI:1447447735
Name:PEDRO R. HERNANDEZ M.D. P.A.
Entity type:Organization
Organization Name:PEDRO R. HERNANDEZ M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:R
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-355-3364
Mailing Address - Street 1:1901 MEDI PARK DR
Mailing Address - Street 2:SUITE 138
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2110
Mailing Address - Country:US
Mailing Address - Phone:806-355-3364
Mailing Address - Fax:806-355-0108
Practice Address - Street 1:1901 MEDI PARK DR
Practice Address - Street 2:SUITE 138
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2110
Practice Address - Country:US
Practice Address - Phone:806-355-3364
Practice Address - Fax:806-355-0108
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDRO R. HERNANDEZ M.D.P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-01
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5385174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX134882305Medicaid
TX134882305Medicaid
TX1548257900Medicare PIN