Basic Information
| Provider Information | |||||||||
| NPI: | 1447412895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | FELIPE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4214 ANDREWS HWY STE 240 | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797034817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326866605 | ||||||||
| FaxNumber: | 4326822284 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 ROSALIND REDFERN GROVER PKWY | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797015846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4322211111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2008 | ||||||||
| LastUpdateDate: | 08/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N2563 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | OS10375 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | N2563 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 202275801 | 05 | TX | MEDICAID | 8CA273 | 01 | TX | BCBSTX | OTHER | 1447412895 | 01 | TX | TRICARE SOUTH | OTHER | P00766238 | 01 | TX | RAILROAD MEDICARE | OTHER | 1447412895 | 01 | TX | BCBS TX | OTHER |