Provider Demographics
NPI:1568668176
Name:HERNANDEZ, EDGAR IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:IVAN
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W 38TH ST STE 322
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6400
Mailing Address - Country:US
Mailing Address - Phone:844-867-8444
Mailing Address - Fax:512-402-5171
Practice Address - Street 1:1600 W 38TH ST STE 322
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6400
Practice Address - Country:US
Practice Address - Phone:844-867-8444
Practice Address - Fax:512-402-5171
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0383702084P0800X
TXU68682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry