Provider Demographics
NPI:1427602176
Name:HERNANDEZ GONZALEZ, DANIEL ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ENRIQUE
Last Name:HERNANDEZ GONZALEZ
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 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 MILLER ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4205
Practice Address - Country:US
Practice Address - Phone:336-718-1000
Practice Address - Fax:336-718-1065
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019018155207R00000X
NC2023-02842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty