Provider Demographics
NPI:1932271996
Name:MARTIN JAY HERNANDEZ MD PC
Entity Type:Organization
Organization Name:MARTIN JAY HERNANDEZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-936-3223
Mailing Address - Street 1:711 E MISSOURI AVE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2841
Mailing Address - Country:US
Mailing Address - Phone:623-936-3223
Mailing Address - Fax:623-936-4554
Practice Address - Street 1:711 E MISSOURI AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2841
Practice Address - Country:US
Practice Address - Phone:623-936-3223
Practice Address - Fax:623-936-4554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1932271996OtherMEDICARE NPI
AZI08478Medicare UPIN
AZ1932271996Medicare PIN