Provider Demographics
NPI:1932130143
Name:HERNANDEZ, LUIS N (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:N
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:PO BOX 5478
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-5478
Mailing Address - Country:US
Mailing Address - Phone:985-493-4004
Mailing Address - Fax:985-493-4081
Practice Address - Street 1:726 N ACADIA RD
Practice Address - Street 2:SUITE 2400
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4847
Practice Address - Country:US
Practice Address - Phone:985-493-4090
Practice Address - Fax:985-493-4081
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15684207LP2900X
LA015684208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1359441Medicaid
LA247765Y7WMedicare PIN
LAB63157Medicare UPIN
LA51551Medicare ID - Type Unspecified