Individual
THOMAS HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
215 E 1ST ST STE 326, DIXON, IL 61021-3190
(815) 285-5800
(815) 285-5691
Mailing address
337 OLD SALEM WAY, MARTINEZ, GA 30907-9081
(706) 210-1825
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036-129768
IL
207XP3100X
Pediatric Orthopaedic Surgery Physician
BM6733807-R49
GA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
036-129768
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036129768
—
IL
01
—
381220030
MEDICARE
IL
01
—
BM6733807-R49
TEMP RESIDENCY TRAINING #
GA
Enumeration date
05/03/2007
Last updated
11/20/2024
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