Provider Demographics
NPI:1912991472
Name:HERNANDEZ, ALEXANDER VALENTINE (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:VALENTINE
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 1:301 MULBERRY CT
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3750
Mailing Address - Country:US
Mailing Address - Phone:850-729-3646
Mailing Address - Fax:
Practice Address - Street 1:307 BOATNER RD
Practice Address - Street 2:
Practice Address - City:EGLIN
Practice Address - State:FL
Practice Address - Zip Code:32542-1391
Practice Address - Country:US
Practice Address - Phone:850-883-8227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4915146D00000X
FLME85447207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133225613Medicaid
FL51356OtherBCBS FL
TX8R6723OtherBCBS
TX8K9302OtherBCBS
AL059185982OtherBCBS AL
TX133225612Medicaid
FL264962400Medicaid
TX8D6595Medicare PIN
TX133225612Medicaid
FL51356FMedicare PIN
FL51356OtherBCBS FL
TX133225613Medicaid
TX8B9191Medicare PIN
FL51356XMedicare PIN