Basic Information
| Provider Information | |||||||||
| NPI: | 1386725877 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | RAUL | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 78 | ||||||||
| Address2: | |||||||||
| City: | RIO GRANDE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785820078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564875561 | ||||||||
| FaxNumber: | 9564874680 | ||||||||
| Practice Location | |||||||||
| Address1: | 2573 HOSPITAL COURT | ||||||||
| Address2: | |||||||||
| City: | RIO GRANDE CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9564875561 | ||||||||
| FaxNumber: | 9564874680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 04/13/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | M3256 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | M3256 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 189278801 | 05 | TX | MEDICAID | 8W8200 | 01 | TX | BCBS | OTHER |