Individual
MR. ALFONSO JR HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
466 HORROCKS DR, BLACKFOOT, ID 83221-3452
(307) 399-5925
Mailing address
466 HORROCKS DR, BLACKFOOT, ID 83221-3452
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1530
ID
Other
Enumeration date
07/28/2017
Last updated
02/22/2018
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