MEDICARE: DR. JESUS EDWARD HERNANDEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	K7165	TX

General Provider Information

NPI Number	:	1437183910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESUS EDWARD HERNANDEZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 18103
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77496-8103
Country	:	US
Telephone Number	:	281-980-1742
Fax Number	:	281-980-1754

Provider Business Practice Location Address
First Line	:	7616 BRANFORD PL STE 320
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-3794
Country	:	US
Telephone Number	:	281-980-1742
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	06/02/2023

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