Provider Demographics
NPI:1891765459
Name:HERNANDEZ, ALFRED D (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:D
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 1:1849 S OSPREY AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3614
Mailing Address - Country:US
Mailing Address - Phone:941-957-4767
Mailing Address - Fax:941-955-7334
Practice Address - Street 1:1849 S OSPREY AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3614
Practice Address - Country:US
Practice Address - Phone:941-957-4767
Practice Address - Fax:941-955-7334
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45255207N00000X, 207ND0101X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP02214960OtherRAILROAD MEDICARE
FL58500Medicare ID - Type Unspecified