Individual
THOMAS R HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4801 BECKNER RD, LEVEL 2 POD 1 STE 2600, SANTA FE, NM 87507-0000
(505) 772-2000
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD00033054
WA
208000000X
Pediatrics Physician
MD2021-0914
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8191884
DSHS NUMBER
WA
Enumeration date
01/02/2006
Last updated
11/10/2021
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