MEDICARE: PEDRO R HERNANDEZ M.D. P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	E5385	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	115014100	OTHER	TX	FIRSTCARE/SOUTHWEST LIFE
2	00RJ36	OTHER	TX	BCBS OF TEXAS
3	4209208	OTHER	TX	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548257900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEDRO R HERNANDEZ M.D. P.A.

Provider Business Mailing Address
First Line	:	1901 MEDI PARK
Second Line	:	SUITE 138
City	:	AMARILLO
State	:	TX
Zip	:	79106-2110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 MEDI PARK
Second Line	:	SUITE 138
City	:	AMARILLO
State	:	TX
Zip	:	79106-2110
Country	:	US
Telephone Number	:	806-355-3364
Fax Number	:	806-355-0108

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	06/20/2019

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Directions to “ PEDRO R HERNANDEZ M.D. P.A.” Practice Location

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