Provider Demographics
NPI:1477525384
Name:HERNANDEZ, MAXIMILIANO E (MD)
Entity type:Individual
Prefix:
First Name:MAXIMILIANO
Middle Name:E
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 644
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1612
Mailing Address - Country:US
Mailing Address - Phone:956-702-1013
Mailing Address - Fax:956-781-5579
Practice Address - Street 1:502 S CAGE BLVD
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577
Practice Address - Country:US
Practice Address - Phone:956-702-1013
Practice Address - Fax:956-781-5579
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1471207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB100690OtherMEDICARE
TX110217993OtherRAILROAD MEDICARE
TX8CQ990OtherBCBS
TXP00848543OtherRAILROAD MEDICARE
TX029437302Medicaid
TX029437301Medicaid
TX0003AMOtherBLUE CROSS BLUE SHIELD
TX0003AMMedicare PIN