Healthcare Provider Details

I. General information

NPI: 1851513089
Provider Name (Legal Business Name): THOMAS HERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TOMMY HERNANDEZ M.D.

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E 1ST ST STE 326
DIXON IL
61021-3190
US

IV. Provider business mailing address

337 OLD SALEM WAY
MARTINEZ GA
30907-9081
US

V. Phone/Fax

Practice location:
  • Phone: 815-285-5800
  • Fax: 815-285-5691
Mailing address:
  • Phone: 706-210-1825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberBM6733807-R49
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number036-129768
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036-129768
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: