Provider Demographics
NPI:1235594706
Name:LEONEL J HERNANDEZ,MD
Entity Type:Organization
Organization Name:LEONEL J HERNANDEZ,MD
Other - Org Name:LEONEL J HERNANDEZ-TOLEDO, MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LEONEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-764-3954
Mailing Address - Street 1:1777 S ANDREWS AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2517
Mailing Address - Country:US
Mailing Address - Phone:954-764-3054
Mailing Address - Fax:954-462-3286
Practice Address - Street 1:1777 S ANDREWS AVE STE 202
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2517
Practice Address - Country:US
Practice Address - Phone:954-764-3054
Practice Address - Fax:954-462-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME40895207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMHWYMOtherBLUE CROSS/BLUE SHIELD