Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036-129768 | IL |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | BM6733807-R49 | GA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 036-129768 | IL |
NPI | 1851513089 |
---|---|
Provider Name | Thomas Hernandez |
First Address | Martinez, GA 30907-9081 |
Second Address | Dixon, IL 61021-3190 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 23/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036129768 | (05) | IL |
20496 | (02) | GA |
381220030 | MEDICARE (01) | IL |
BM6733807-R49 | TEMP RESIDENCY TRAINING # (01) | GA |