Hernandez, Mark Edward

Hernandez, Mark Edward is an individual health care provider with primary practice located at 302 S 1St Ave , Sandpoint ID 83864-1258. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Hernandez, Mark Edward can be contacted via phone (208) 263-5109.

Contact Information

Primary practice address
302 S 1St Ave Sandpoint ID 83864-1258
Fax: (208) 263-5112
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X M6092 Idaho

Profile Details

NPI number 1457416224
LBN Legal business name Hernandez, Mark Edward
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 22nd, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457416224 NPPES
Idaho MEDICAID 002717200

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