Provider Demographics
NPI:1760516462
Name:HERNANDEZ, JOEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:D
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 1:910 N WASHINGTON ST
Mailing Address - Street 2:STE. 209
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2202
Mailing Address - Country:US
Mailing Address - Phone:509-232-1192
Mailing Address - Fax:509-232-1165
Practice Address - Street 1:101 W 8TH AVE
Practice Address - Street 2:STE. 100, L-1
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2307
Practice Address - Country:US
Practice Address - Phone:509-232-1192
Practice Address - Fax:509-232-1165
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000472052080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB32999OtherMEDICARE GROUP
WA807680300OtherIDAHO MEDICAID
WA8480683OtherWA MEDICAID
WAG8864785OtherMEDICARE PTAN
WAG8864785OtherMEDICARE PTAN