Provider Demographics
NPI:1568462398
Name:HERNANDEZ, JESUS A (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:125 W HAGUE RD
Mailing Address - Street 2:SUITE 590
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5814
Mailing Address - Country:US
Mailing Address - Phone:915-532-1620
Mailing Address - Fax:915-544-3852
Practice Address - Street 1:125 W HAGUE RD
Practice Address - Street 2:SUITE 590
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5814
Practice Address - Country:US
Practice Address - Phone:915-532-1620
Practice Address - Fax:915-544-3852
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ1264207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
100009355OtherRR MEDICARE
TX125614101Medicaid
89V092Medicare PIN
F23491Medicare UPIN