Provider Demographics
NPI:1588678684
Name:HERNANDEZ, RAUL ALBERTO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:ALBERTO
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2809 BELL ST STE A
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1741
Mailing Address - Country:US
Mailing Address - Phone:740-453-5003
Mailing Address - Fax:740-452-8826
Practice Address - Street 1:2809 BELL ST STE A
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1741
Practice Address - Country:US
Practice Address - Phone:740-453-5003
Practice Address - Fax:740-452-8826
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-0804-H174400000X
OH35060804207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0811992Medicaid
OHC00524Medicare UPIN
OH0811992Medicaid