Individual
WILSON LEON HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12606 GREENVILLE AVE, SUITE 160, DALLAS, TX 75243-1921
(214) 691-9377
(214) 853-9415
Mailing address
3600 GASTON AVE, SUITE 1205, DALLAS, TX 75246-1800
(214) 692-8262
(214) 696-4190
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
K3232
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
042232104
—
TX
01
—
8AE57
BCBS PROVIDER ID
TX
01
—
P00473193
RRMCR PROVIDER
TX
Enumeration date
10/14/2005
Last updated
01/31/2017
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