Provider Demographics
NPI:1578505665
Name:HERNANDEZ, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
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 1:1619 COMMON ST
Mailing Address - Street 2:SUITE 902
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3452
Mailing Address - Country:US
Mailing Address - Phone:830-214-0104
Mailing Address - Fax:830-358-7371
Practice Address - Street 1:1619 COMMON STREET
Practice Address - Street 2:SUITE 902
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3461
Practice Address - Country:US
Practice Address - Phone:830-214-0104
Practice Address - Fax:830-358-7371
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4148207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190833701Medicaid
TXI52116Medicare UPIN
TX190833701Medicaid