Provider Demographics
NPI:1184879900
Name:HERNANDEZ, DAVID GREGORY (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GREGORY
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:1400 SOUTH DOBSON ROAD
Mailing Address - Street 2:ATTN: BMG HOSPITALIST TEAM/AMANDA GUMP
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202
Mailing Address - Country:US
Mailing Address - Phone:480-412-6788
Mailing Address - Fax:480-412-6848
Practice Address - Street 1:1400 SOUTH DOBSON ROAD
Practice Address - Street 2:ATTN: BMG HOSPITALIST TEAM/AMANDA GUMP
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-412-6788
Practice Address - Fax:480-412-6848
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-2092-17207R00000X
AZ006599207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA-2092-17OtherNM OSTEOPATHIC LICENSE