Provider Demographics
NPI:1558379313
Name:HERNANDEZ, HUGO (MD)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10111 W FOREST HILL BLVD
Mailing Address - Street 2:#200
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6108
Mailing Address - Country:US
Mailing Address - Phone:561-798-0341
Mailing Address - Fax:561-798-1304
Practice Address - Street 1:10111 W FOREST HILL BLVD
Practice Address - Street 2:#200
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6108
Practice Address - Country:US
Practice Address - Phone:561-798-0341
Practice Address - Fax:561-798-1304
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0022224208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D85891Medicare UPIN
50952Medicare ID - Type Unspecified