Provider Demographics
NPI:1942220124
Name:HERNANDEZ, RUBEN B (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:B
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 1:3617 WILDERNESS BLVD W
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-9350
Mailing Address - Country:US
Mailing Address - Phone:941-721-0649
Mailing Address - Fax:
Practice Address - Street 1:4333 N. HWY 301
Practice Address - Street 2:
Practice Address - City:ELLENTON
Practice Address - State:FL
Practice Address - Zip Code:34222
Practice Address - Country:US
Practice Address - Phone:941-721-0649
Practice Address - Fax:941-721-6080
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45811207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine