Individual
RUBEN HERNAN HERNANDEZ MONDRAGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1040 WISHARD BLVD, INDIANAPOLIS, IN 46202-2872
(317) 962-8893
(317) 962-2990
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01065039A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000591255
ANTHEM
IN
05
—
200898960
—
IN
Enumeration date
04/17/2008
Last updated
05/23/2025
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