Provider Demographics
NPI:1437351806
Name:HERNANDEZ, RICK J (MD)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:J
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3960 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-8184
Mailing Address - Country:US
Mailing Address - Phone:910-454-4343
Mailing Address - Fax:910-457-9209
Practice Address - Street 1:3960 EXECUTIVE PARK BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-8184
Practice Address - Country:US
Practice Address - Phone:910-454-4343
Practice Address - Fax:910-457-9209
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2008-01465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913552Medicaid
NC5913552Medicaid