Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 048887 | MI |
NPI | 1104860030 |
---|---|
Provider Name | Dr. Jesus Hernandez JR. |
First Address | Ann Arbor, MI 48105-1598 |
Second Address | Clare, MI 48617-1409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 11/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102865106 | (05) | MI |
104081910 | (05) | MI |
A78934 | (02) | |
JH048887 | BLUE SHIELD (01) | MI |