Provider Demographics
NPI:1124288089
Name:HERNANDEZ, ERIC JAMES (MD)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JAMES
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6525 GUNPARK DR STE 370-202
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-3346
Mailing Address - Country:US
Mailing Address - Phone:720-799-7473
Mailing Address - Fax:720-293-1122
Practice Address - Street 1:6525 GUNPARK DR STE 370-202
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3346
Practice Address - Country:US
Practice Address - Phone:720-799-7473
Practice Address - Fax:720-293-1122
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49265207Q00000X, 207Q00000X
WAML20009035390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12778575Medicaid
CO49265OtherMEDICAL LICENSE
CO12778575Medicaid