Provider Demographics
NPI:1508934811
Name:HERNANDEZ, THELMA (MD)
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
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 797
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-0797
Mailing Address - Country:US
Mailing Address - Phone:254-694-5092
Mailing Address - Fax:254-694-7039
Practice Address - Street 1:2009 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2336
Practice Address - Country:US
Practice Address - Phone:254-694-5092
Practice Address - Fax:254-694-7039
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7978207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX09998002Medicaid
TXC16847Medicare UPIN
TX00RH08Medicare ID - Type Unspecified