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General NPI Number Information
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NPI Number | 1871811067
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Entity Type | Individual
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Provider Name | MANUEL R HERNANDEZ III MD
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Gender | Male
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 10918 ELM AVE
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City | KANSAS CITY
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State | MO
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Zip | 64134-4108
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Country | US
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Telephone | 816-986-5240
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Fax | 816-767-4158
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Provider Business Mailing Address
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Address Line | 901 E 104TH ST MAILSTOP 400S
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City | KANSAS CITY
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State | MO
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Zip | 64131
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Country | US
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Telephone | 816-932-1711
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2015022436
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 2015022436
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License Number State | MO
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