Healthcare Provider Details

I. General information

NPI: 1093783490
Provider Name (Legal Business Name): MARK STEVEN HERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 15TH ST BRACKENRIDGE HOSPITAL ANNEX
AUSTIN TX
78701-1930
US

IV. Provider business mailing address

902 POLISHED STONE CV
PFLUGERVILLE TX
78660-4795
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-8355
  • Fax: 512-477-8933
Mailing address:
  • Phone: 512-990-0123
  • Fax: 512-477-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM2976
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: