Provider Demographics
NPI:1235104167
Name:HERNANDEZ, RICHARD E
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
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 560130
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-0130
Mailing Address - Country:US
Mailing Address - Phone:305-360-9244
Mailing Address - Fax:305-630-9223
Practice Address - Street 1:7765 SW 87TH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2596
Practice Address - Country:US
Practice Address - Phone:305-274-0808
Practice Address - Fax:305-274-8311
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043730207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051968500Medicaid
FLD84359Medicare UPIN
FL11228Medicare ID - Type Unspecified