Provider Demographics
NPI:1821301979
Name:JUAN A. HERNANDEZ, M.D., P.A.
Entity Type:Organization
Organization Name:JUAN A. HERNANDEZ, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-634-7225
Mailing Address - Street 1:232 N JOHN REDDITT DR STE B
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-2620
Mailing Address - Country:US
Mailing Address - Phone:936-634-7225
Mailing Address - Fax:936-639-4549
Practice Address - Street 1:232 N JOHN REDDITT DR STE B
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-2620
Practice Address - Country:US
Practice Address - Phone:936-634-7225
Practice Address - Fax:936-639-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB109750Medicare PIN