Provider Demographics
NPI:1548257900
Name:HERNANDEZ, PEDRO R (MD PA)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:R
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 MEDI PARK
Mailing Address - Street 2:SUITE 138
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 MEDI PARK
Practice Address - Street 2:SUITE 138
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2110
Practice Address - Country:US
Practice Address - Phone:806-355-3364
Practice Address - Fax:806-355-0108
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5385207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115014100OtherFIRSTCARE/SOUTHWEST LIFE
TX00RJ36OtherBCBS OF TEXAS
TX4209208OtherAETNA
NME7319Medicaid
TX134882305Medicaid
NME7319Medicaid
TX00RJ36OtherBCBS OF TEXAS
TX00RJ36Medicare PIN