Provider Demographics
NPI:1770540684
Name:ELIEZER HERNANDEZ MD P.A.
Entity type:Organization
Organization Name:ELIEZER HERNANDEZ MD P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIEZER
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:830-773-9449
Mailing Address - Street 1:PO BOX 1145
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78853-1145
Mailing Address - Country:US
Mailing Address - Phone:830-773-9449
Mailing Address - Fax:830-757-3142
Practice Address - Street 1:1975 N VETERANS BLVD
Practice Address - Street 2:STE. 5
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4456
Practice Address - Country:US
Practice Address - Phone:830-773-9449
Practice Address - Fax:830-757-3142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6834261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063670601Medicaid
TX153805002Medicaid
TX153805001Medicaid