Provider Demographics
NPI:1679538797
Name:CARRION, HERNAN M (MD)
Entity Type:Individual
Prefix:
First Name:HERNAN
Middle Name:M
Last Name:CARRION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9165 PARK DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-3163
Mailing Address - Country:US
Mailing Address - Phone:305-545-6685
Mailing Address - Fax:786-515-0254
Practice Address - Street 1:1321 NW 14TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1673
Practice Address - Country:US
Practice Address - Phone:305-547-2534
Practice Address - Fax:305-326-7210
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME20544208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053422600Medicaid
FL10D0877365OtherCLIA NUMBER
FL053422600Medicaid
FL10D0877365OtherCLIA NUMBER
FL91694YMedicare PIN