| Organization Name: | MOREHOUSE INTERNAL MEDICINE CLINIC |
| NPI Number: | 1063796571 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARLOS HERNANDEZ (PHYSICIAN ASSISTANT) |
| Mailing Address: | 420 Gunby Ave Bastrop |
| State: | LA US |
| Postal Code: | 712204406 |
| Phone Number: | 3188124663 |
| Fax Number: | |
| NPI Enumeration Date: | 10/03/2011 |
| NPI Last Update Date: | 10/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | A10630RX |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |