Healthcare Provider Details

I. General information

NPI: 1750322269
Provider Name (Legal Business Name): JOSEPH M HERNANDEZ III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17720 CORPORATE WOODS DR
SAN ANTONIO TX
78259-3500
US

IV. Provider business mailing address

PO BOX 461448
SAN ANTONIO TX
78246-1448
US

V. Phone/Fax

Practice location:
  • Phone: 210-491-9400
  • Fax: 210-491-3550
Mailing address:
  • Phone: 210-495-3627
  • Fax: 210-491-3581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberK7555
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberK7555
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: