Individual
DR. JOSE J. HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1608 MAIN ST, CONWAY, SC 29526-3572
(843) 248-4700
Mailing address
4303 LIVE OAK DR, LITTLE RIVER, SC 29566-9138
(843) 663-8000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
32074
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
320744
—
SC
01
—
AA67448552
MEDICARE PTAN
SC
Enumeration date
07/20/2009
Last updated
09/24/2021
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