Healthcare Provider Details

I. General information

NPI: 1386725877
Provider Name (Legal Business Name): RAUL G HERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2573 HOSPITAL COURT
RIO GRANDE CITY TX
78582
US

IV. Provider business mailing address

PO BOX 78
RIO GRANDE CITY TX
78582-0078
US

V. Phone/Fax

Practice location:
  • Phone: 956-487-5561
  • Fax: 956-487-4680
Mailing address:
  • Phone: 956-487-5561
  • Fax: 956-487-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberM3256
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberM3256
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: