Healthcare Provider Details

I. General information

NPI: 1164837696
Provider Name (Legal Business Name): JOSEPH PETER HERNANDEZ III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5788 ECKHERT RD
SAN ANTONIO TX
78240-3900
US

IV. Provider business mailing address

5788 ECKHERT RD
SAN ANTONIO TX
78240-3900
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-6450
  • Fax:
Mailing address:
  • Phone: 210-450-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberT3100
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number78885
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberT3100
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: