Provider Demographics
NPI:1386725877
Name:HERNANDEZ, RAUL G (MD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:G
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 78
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-0078
Mailing Address - Country:US
Mailing Address - Phone:956-487-5561
Mailing Address - Fax:956-487-4680
Practice Address - Street 1:2573 HOSPITAL COURT
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582
Practice Address - Country:US
Practice Address - Phone:956-487-5561
Practice Address - Fax:956-487-4680
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3256207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189278801Medicaid
TX8W8200OtherBCBS
8L9246Medicare PIN
TXI72780Medicare UPIN