Provider Demographics
NPI:1558303701
Name:HERNANDEZ, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15421 SW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2215
Mailing Address - Country:US
Mailing Address - Phone:786-348-5921
Mailing Address - Fax:305-271-2412
Practice Address - Street 1:9240 SW 72ND ST
Practice Address - Street 2:SUITE 241
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3261
Practice Address - Country:US
Practice Address - Phone:305-271-1919
Practice Address - Fax:305-271-1911
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME93278207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29304XOtherMEDICARE PTAN
FL29304XOtherMEDICARE PTAN