Provider Demographics
NPI:1194763490
Name:HERNANDEZ, JORGE ENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ENRIQUE
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:PO BOX 1385
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-1385
Mailing Address - Country:US
Mailing Address - Phone:252-209-3159
Mailing Address - Fax:252-209-3049
Practice Address - Street 1:500 ACADEMY ST S
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3248
Practice Address - Country:US
Practice Address - Phone:252-209-3159
Practice Address - Fax:252-209-3049
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1384YOtherBCBS OF NC
NC194008OtherMEDCOST
NC5900468Medicaid
NC5900468Medicaid
NC1384YOtherBCBS OF NC