=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447447735
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEDRO R. HERNANDEZ M.D. P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2007
-----------------------------------------------------
Last Update Date | 10/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1901 MEDI PARK DR SUITE 138
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79106-2110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-355-3364
-----------------------------------------------------
Fax | 806-355-0108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1901 MEDI PARK DR SUITE 138
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79106-2110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-355-3364
-----------------------------------------------------
Fax | 806-355-0108
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PEDRO R. HERNANDEZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 806-355-3364
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | E5385
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------