Provider Demographics
NPI:1033217245
Name:HERNANDEZ, ELIEZER (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIEZER
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:PO BOX 1145
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78853-1145
Mailing Address - Country:US
Mailing Address - Phone:830-773-9449
Mailing Address - Fax:830-757-3142
Practice Address - Street 1:1975 N VETERANS BLVD
Practice Address - Street 2:STE 5
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4456
Practice Address - Country:US
Practice Address - Phone:830-773-9449
Practice Address - Fax:830-757-3142
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6834305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A0055Medicare ID - Type UnspecifiedINDIVIDUAL
TXF91442Medicare UPIN
TX45-8987Medicare ID - Type UnspecifiedRHMEDICARE #