Provider Demographics
NPI:1003954322
Name:HERNANDEZ, GEORG (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORG
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4468 E ENCINAS AVE
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-3475
Mailing Address - Country:US
Mailing Address - Phone:480-218-4313
Mailing Address - Fax:
Practice Address - Street 1:4001 E BASELINE RD STE 105
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2744
Practice Address - Country:US
Practice Address - Phone:480-632-5378
Practice Address - Fax:480-632-1821
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ134132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ67313Medicare ID - Type Unspecified
AZE00213Medicare UPIN