Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | TD071045 | ME |
Y | 208600000X | Surgeon | TD071045 | ME |
NPI | 1003008327 |
---|---|
Provider Name | Pedro Hernandez |
First Address | Jacksonville, FL 32256-6017 |
Second Address | Asheboro, NC 27203-5434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2007 |
Last Update Date | 24/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2011-01205 | MD LICENSE (01) | NC |
TD71045 | MAINE TEMPORARY LICENSE (01) | ME |