Provider Demographics
NPI:1306825021
Name:HERNANDEZ-MEJIA, TOMAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:A
Last Name:HERNANDEZ-MEJIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TOMAS
Other - Middle Name:A
Other - Last Name:HERNANDEZ-MEJIA-TORT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5908 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-6605
Mailing Address - Country:US
Mailing Address - Phone:509-547-4724
Mailing Address - Fax:509-547-4881
Practice Address - Street 1:5908 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-6605
Practice Address - Country:US
Practice Address - Phone:509-547-4724
Practice Address - Fax:509-547-4881
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033572207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1116896Medicaid
WA00033572OtherWA STATE LICENSE
AB39975Medicare ID - Type Unspecified
WA00033572OtherWA STATE LICENSE