Healthcare Provider Details

I. General information

NPI: 1790275394
Provider Name (Legal Business Name): PHYSICIAN MEDICAL MANAGEMENT PARTNERS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 W 15TH ST
PLANO TX
75075-7731
US

IV. Provider business mailing address

850 S GREENVILLE AVE STE 105
RICHARDSON TX
75081-5046
US

V. Phone/Fax

Practice location:
  • Phone: 972-370-5771
  • Fax: 972-674-2788
Mailing address:
  • Phone: 972-765-2346
  • Fax: 972-848-0525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT HERNANDEZ
Title or Position: CEO
Credential: MD
Phone: 903-868-0808