Provider Demographics
NPI:1437183910
Name:HERNANDEZ, JESUS EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:EDWARD
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:PO BOX 18103
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-8103
Mailing Address - Country:US
Mailing Address - Phone:281-980-1742
Mailing Address - Fax:281-980-1754
Practice Address - Street 1:7616 BRANFORD PL STE 320
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3794
Practice Address - Country:US
Practice Address - Phone:281-980-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7165174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F3201Medicare PIN
TXH62480Medicare UPIN