MEDICARE: THELMA M HERNANDEZ MD PA

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	207L00000X	Anesthesiology Physician	E7879	TX

General Provider Information

NPI Number	:	1659682466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THELMA M HERNANDEZ MD PA

Provider Business Mailing Address
First Line	:	2007 SHADOW RIDGE DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76006-2735
Country	:	US
Telephone Number	:	817-640-0210
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 N JEFFERSON AVE
Second Line	:
City	:	MT PLEASANT
State	:	TX
Zip	:	75455-2336
Country	:	US
Telephone Number	:	903-572-6655
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. THELMA M HERNANDEZ
Credential	:	MD
Telephone Number	:	817-640-0120

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	06/25/2010

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