Provider Demographics
NPI:1649607920
Name:JOSE G HERNANDEZ MD LLC
Entity type:Organization
Organization Name:JOSE G HERNANDEZ MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:G
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-323-3193
Mailing Address - Street 1:205 W BOUTZ RD
Mailing Address - Street 2:BLDG #1
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3259
Mailing Address - Country:US
Mailing Address - Phone:575-532-7000
Mailing Address - Fax:575-532-7111
Practice Address - Street 1:2801 E MISSOURI AVE
Practice Address - Street 2:STE 9
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5061
Practice Address - Country:US
Practice Address - Phone:575-323-3193
Practice Address - Fax:575-652-4675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty