Provider Demographics
NPI:1073628947
Name:MORENO, HERNAN (MD)
Entity Type:Individual
Prefix:
First Name:HERNAN
Middle Name:
Last Name:MORENO
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 1:200 RIVERHILLS BUSINESS PARK
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-8112
Mailing Address - Country:US
Mailing Address - Phone:205-995-0899
Mailing Address - Fax:205-995-0451
Practice Address - Street 1:200 RIVERHILLS BUSINESS PARK
Practice Address - Street 2:SUITE 250
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-8112
Practice Address - Country:US
Practice Address - Phone:205-995-0899
Practice Address - Fax:205-995-0451
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7599208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
C79111Medicare UPIN