Provider Demographics
NPI:1346263126
Name:HERNANDEZ, EDWARD VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:VICTOR
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 1:2810 N TELSHOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8230
Mailing Address - Country:US
Mailing Address - Phone:575-523-2020
Mailing Address - Fax:575-521-1553
Practice Address - Street 1:2810 N TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8230
Practice Address - Country:US
Practice Address - Phone:575-523-2020
Practice Address - Fax:575-521-1553
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2009-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6187207W00000X
NM98290207W00000X
CAG080256207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS8436Medicaid
NMG68986Medicare UPIN