Individual
DR. MARK EDWARD HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
302 S 1ST AVE, SANDPOINT, ID 83864-1258
(208) 263-5109
(208) 263-5112
Mailing address
290 PONDER POINT DR, SANDPOINT, ID 83864-8657
(208) 263-1588
(208) 263-5112
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M6092
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002717200
—
ID
Enumeration date
12/22/2006
Last updated
07/08/2007
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