Provider Demographics
NPI:1932175247
Name:HERNANDEZ, ELIEZER (MD)
Entity Type:Individual
Prefix:
First Name:ELIEZER
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:PO BOX 1057
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-1057
Mailing Address - Country:US
Mailing Address - Phone:561-753-0001
Mailing Address - Fax:561-753-0005
Practice Address - Street 1:1447 MEDICAL PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3164
Practice Address - Country:US
Practice Address - Phone:561-753-0001
Practice Address - Fax:561-753-0005
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219881207R00000X
FLME89631207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000340100Medicaid
FL000340100Medicaid
H87443Medicare UPIN
NY837V61Medicare ID - Type Unspecified
FL0003410100Medicaid
FLAT264ZMedicare Oscar/Certification