Provider Demographics
NPI:1871811067
Name:HERNANDEZ, MANUEL R III (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:R
Last Name:HERNANDEZ
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-932-1711
Mailing Address - Fax:
Practice Address - Street 1:10918 ELM AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64134-4108
Practice Address - Country:US
Practice Address - Phone:816-986-5240
Practice Address - Fax:816-767-4158
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2015022436208000000X, 2084P0804X
KYR2489208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry