Organization
MOREHOUSE INTERNAL MEDICINE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARLOS HERNANDEZ PA-C (PHYSICIAN ASSISTANT)
(318) 812-4663
Entity
Organization
Contact information
Practice address
420 GUNBY AVE, BASTROP, LA 71220-4406
(318) 812-4663
Mailing address
420 GUNBY AVE, BASTROP, LA 71220-4406
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
A10630RX
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1625892
—
LA
Enumeration date
10/03/2011
Last updated
10/03/2011
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