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General NPI Number Information
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NPI Number | 1851513089
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Entity Type | Individual
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Provider Name | THOMAS HERNANDEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 215 E 1ST ST STE 326
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City | DIXON
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State | IL
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Zip | 61021-3190
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Country | US
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Telephone | 815-285-5800
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Fax | 815-285-5691
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Provider Business Mailing Address
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Address Line | 337 OLD SALEM WAY
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City | MARTINEZ
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State | GA
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Zip | 30907-9081
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Country | US
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Telephone | 706-210-1825
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | BM6733807-R49
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 036-129768
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 036-129768
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License Number State | IL
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