Provider Demographics
NPI:1144219858
Name:HERNANDEZ, ROBERTO J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:J
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 1:4425 WATER EDGE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-2548
Mailing Address - Country:US
Mailing Address - Phone:956-357-1726
Mailing Address - Fax:
Practice Address - Street 1:2101 PEASE ST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8307
Practice Address - Country:US
Practice Address - Phone:956-364-0482
Practice Address - Fax:956-364-1255
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1758207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM1758OtherTEXAS MEDICAL LICENSE
TX178122101Medicaid
TX178122102Medicaid
TX8D9260Medicare PIN
TXI42196Medicare UPIN