Provider Demographics
NPI:1568406619
Name:HERNANDEZ, EDWARD RAY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:RAY
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-6700
Mailing Address - Fax:985-230-1528
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-6700
Practice Address - Fax:985-230-1528
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA2012002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07677021Medicaid
P00606643OtherRR MEDICARE
LA1409502Medicaid
I48299Medicare UPIN
LA1409502Medicaid